Point-of-Care Ultrasonography: Focused Versus Generalized Approaches to Scanning
- PDF / 169,752 Bytes
- 2 Pages / 595.276 x 790.866 pts Page_size
- 44 Downloads / 148 Views
J Gen Intern Med DOI: 10.1007/s11606-020-06290-3 © Society of General Internal Medicine (This is a U.S. government work and not under copyright protection in the U.S.; foreign copyright protection may apply) 2020
use of diagnostic point-of-care ultrasonography T he(POCUS) by generalists has become increasingly common in recent years. Support for POCUS by influential internal medicine societies such as the American College of Physicians; Society of Hospital Medicine; and the Alliance for Academic Internal Medicine, coupled with the ubiquity of educational opportunities, has spurred its adoption by generalists and suggests it will become a requisite skill in the near future. Traditionally, clinicians have conceived of diagnostic POCUS as a focused scan performed to answer a specific clinical question that arises from a patient’s history or physical exam.1, 2 Indeed, the majority of studies supporting the accuracy and usefulness of POCUS evaluate its ability to interrogate a single organ system or determine the presence/absence of a particular abnormality.3 However, as the enthusiasm for POCUS has grown, some experts have begun to advocate for expanding the use of POCUS, supporting its routine use for generalized assessments that interrogate several organ systems. One protocol that has gained prominence has the clinician obtain parasternal, epigastric, apical/anterior, right upper quadrant, left upper quadrant, and suprapubic views (PEARLS) “whenever a thorough physical examination is indicated.”4 Another protocol, the Ultrasound Screening Exam for Underlying Lesions (USEFUL), has the clinician scan the thyroid, heart, liver, gallbladder, aorta, kidneys, bladder, and prostate or uterus during routine patient encounters.5 While these protocols superficially resemble other well-validated systematic approaches to scanning such as the Focused Assessment with Sonography for Trauma (FAST) and Rapid Ultrasound for Shock and Hypotension (RUSH), they fundamentally differ from Received July 17, 2020 Accepted October 5, 2020
these assessments in that they divorce scanning from clinical history. Admittedly, POCUS does appear an effective screening tool in some well-defined asymptomatic patient groups such as in those deemed at risk for abdominal aortic aneurysm per the United States Preventive Services Task Force (USPSTF). 3 However, regularly scanning several organ systems during routine patient encounters bears little resemblance to using POCUS to perform guideline-directed screenings. These generalized protocols such as PEARLS and USEFUL may seem attractive as they provide a framework to consistently and efficiently perform a multitude of POCUS applications, but several studies show broad exams discover irregularities of varying clinical significance in a substantial minority of patients and have diminished accuracy compared with targeted exams.3 One representative study had family physicians evaluate asymptomatic patients with traditional physical exam at a periodic health evaluation and subsequently had another family phys
Data Loading...
