Open Collections

Parajulee, Anshu

University of British Columbia

Introduction: Point of care ultrasound (PoCUS), an exam performed and usually interpreted at the bedside, has the potential to improve the quality of rural healthcare and make rural practice more sustainable for physicians. Yet, there are few clinical studies on the usefulness and quality of this tool in rural communities. This study aimed to understand the effect of PoCUS on rural GPs’ diagnostic certainty and clinical decision making, and the accuracy of their exams. Methods: Rural GPs in the Canadian province of British Columbia (BC) collected prospective pre/post PoCUS survey data on their diagnostic probability (0-100% continuous scale) for a main working diagnosis and their patient management plan. The Wilcoxon signed rank test for clustered data was used to assess the statistical significance of observed changes from pre to post PoCUS in diagnostic certainty (an ordinal scale ascertained from diagnostic probability) and the highest level of care included in a patient management plan. Rural GPs also shared images from their PoCUS scans. For each scan, two physician specialists, considered imaging experts for the study, independently interpreted images. GP interpretation was compared to the interpretation of experts. Results: Five GPs, each from a different rural community in BC, collected data on 68 PoCUS exams over two to 10 weeks in 2022-23. Diagnostic certainty increased for 68% of scans (p-value=0.01). The highest level of care in a patient management plan changed for 36% of scans (p-value=0.08); it decreased for 32% and increased for 4%. Seven imaging experts reviewed images for 55 scans. There was inadequate power to precisely assess PoCUS accuracy due to expert reviewers having differing interpretations of images or agreeing that the images provided were inadequate. Discussion: With our study, we have taken an initial step within the field of clinical PoCUS research in rural Canada. We have generated evidence on the usefulness of PoCUS for rural GPs, which should be validated by larger studies. Our methodological recommendations based on lessons learned during secondary image review can help other researchers design rigorous PoCUS quality studies that yield adequate sample sizes.

Text

2024-12-24

Attribution-NonCommercial-NoDerivatives 4.0 International

http://hdl.handle.net/2429/89993

Population and Public Health

University of British Columbia

UBCV

http://creativecommons.org/licenses/by-nc-nd/4.0/