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      Point-of-care ultrasound (POCUS): unnecessary gadgetry or evidence-based medicine?

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          ABSTRACT

          Over the last decade there has been increasing interest and enthusiasm in point-of-care ultrasound (POCUS) as an aide to traditional examination techniques in assessing acutely unwell adult patients. However, it currently remains the domain of a relatively small handful of physicians within the UK. There are numerous reasons for this, notably a lack of training pathways and supervisors but also a lack of understanding of the evidence base behind this imaging modality. This review article aims to explore some of the evidence base behind POCUS for a number of medical pathologies, and where possible compare it to evidenced traditional examination techniques. We discuss the issues around training in bedside ultrasound and recommend a push to integrate POCUS training into internal medicine curricula and support trainers to comprehensively deliver this.

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          Most cited references28

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          Pleural procedures and thoracic ultrasound: British Thoracic Society Pleural Disease Guideline 2010.

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            Comparative Diagnostic Performances of Auscultation, Chest Radiography, and Lung Ultrasonography in Acute Respiratory Distress Syndrome

            Lung auscultation and bedside chest radiography are routinely used to assess the respiratory condition of ventilated patients with acute respiratory distress syndrome (ARDS). Clinical experience suggests that the diagnostic accuracy of these procedures is poor.
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              Is Open Access

              Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis

              Background Guidelines do not currently recommend the use of lung ultrasound (LUS) as an alternative to chest X-ray (CXR) or chest computerized tomography (CT) scan for the diagnosis of pneumonia. We conducted a meta-analysis to summarize existing evidence of the diagnostic accuracy of LUS for pneumonia in adults. Methods We conducted a systematic search of published studies comparing the diagnostic accuracy of LUS against a referent CXR or chest CT scan and/or clinical criteria for pneumonia in adults aged ≥18 years. Eligible studies were required to have a CXR and/or chest CT scan at the time of evaluation. We manually extracted descriptive and quantitative information from eligible studies, and calculated pooled sensitivity and specificity using the Mantel-Haenszel method and pooled positive and negative likelihood ratios (LR) using the DerSimonian-Laird method. We assessed for heterogeneity using the Q and I2 statistics. Results Our initial search strategy yielded 2726 articles, of which 45 (1.7%) were manually selected for review and 10 (0.4%) were eligible for analyses. These 10 studies provided a combined sample size of 1172 participants. Six studies enrolled adult patients who were either hospitalized or admitted to Emergency Departments with suspicion of pneumonia and 4 studies enrolled critically-ill adult patients. LUS was performed by highly-skilled sonographers in seven studies, by trained physicians in two, and one did not mention level of training. All studies were conducted in high-income settings. LUS took a maximum of 13 minutes to conduct. Nine studies used a 3.5-5 MHz micro-convex transducer and one used a 5–9 MHz convex probe. Pooled sensitivity and specificity for the diagnosis of pneumonia using LUS were 94% (95% CI, 92%-96%) and 96% (94%-97%), respectively; pooled positive and negative LRs were 16.8 (7.7-37.0) and 0.07 (0.05-0.10), respectively; and, the area-under-the-ROC curve was 0.99 (0.98-0.99). Conclusions Our meta-analysis supports that LUS, when conducted by highly-skilled sonographers, performs well for the diagnosis of pneumonia. General practitioners and Emergency Medicine physicians should be encouraged to learn LUS since it appears to be an established diagnostic tool in the hands of experienced physicians.
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                Author and article information

                Contributors
                Role: consultant acute medicine
                Role: consultant acute medicine
                Journal
                Clin Med (Lond)
                Clin Med (Lond)
                RCOP
                Clinical Medicine
                Royal College of Physicians
                1470-2118
                1473-4893
                June 2018
                : 18
                : 3
                : 219-224
                Affiliations
                ASurrey and Sussex Healthcare NHS Trust, Surrey, UK
                BSurrey and Sussex Healthcare NHS Trust, Surrey, UK
                Author notes
                Address for correspondence: Dr Nicholas Smallwood, Surrey and Sussex Healthcare NHS Trust, Department of Acute Medicine, East Surrey Hospital, Canada Avenue, Redhill RH1 5RH, UK. Email: nicholas.smallwood@ 123456nhs.net
                Article
                PMC6334078 PMC6334078 6334078 clinmedicine
                10.7861/clinmedicine.18-3-219
                6334078
                29858431
                1767762a-bd45-446e-a824-7de9e46a79c7
                © Royal College of Physicians 2018. All rights reserved.
                History
                Categories
                Reviews

                clinical review,POCUS,Point-of-care ultrasound,ultrasound,diagnostics

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