Cross-sectional imaging ordered downstream for just 15% of emergency POCUS patients
Using point-of-care ultrasound (POCUS) in emergency settings does not lead to overutilization of follow-up imaging with cross-sectional CT, MRI or additional ultrasounds, according to a study published online May 5 in the European Journal of Radiology.[1]
The study’s authors, from University Medical Center Groningen in the Netherlands, further found that radiologists reading cross-sectional scans for second opinions tend to record few diagnostic disagreements with original POCUS findings from the emergency department.
Senior author Thomas Kwee, MD, PhD, and colleagues reviewed records from 503 patients who presented consecutively in their institution’s ER and underwent POCUS there. The team found 15.3% of these POCUS patients had downstream cross-sectional imaging involving radiology within four weeks of the ER visit.
Top reasons for the follow-up scan orders were suspicion of pathology that went unassessed at the time of the POCUS (59.7%), desire for confirmation of positive or negative POCUS findings (27.3%) and inconclusive POCUS (9.6%).
A few patients received cross-sectional imaging due to a combination of inconclusive POCUS and unassessed suspected pathology (two cases, 2.6%), while one patient needed clarification on incidental findings.
In the 27.3% confirmation cohort, the additional cross-sectional imaging performed by the hospital’s radiology department agreed with the emergency POCUS at a 91% clip.
Commenting on this cohort, Kwee and co-authors noted that “insecurity and/or inexperience of the POCUS operator are the most likely causes of these second opinion requests. This may potentially be reduced with feedback and teaching. Nevertheless, it should be noted that these second opinion requests comprised only 4% of all POCUS examinations.”
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Our findings can be considered reassuring, because they suggest that the use of POCUS does not cause any considerable downstream overutilization of cross-sectional imaging. In addition, POCUS findings appear to be mostly accurate. Importantly, however, the latter only applies to the limited number of heterogeneous cases that was forwarded to the radiology department for a second opinion consultation.”
Kwee et al. acknowledge this as a limitation in their study design and name several others. These include the team’s reliance on POCUS studies performed and read by internal- or emergency-medicine physicians, and the lack at their institution of a working agreement between ER physicians and radiologists on when, how and why to perform emergency POCUS.
“Different types of ultrasound examinations have different levels of complexity, and POCUS operators have different levels of experience and expertise,” the authors point out. “These factors undoubtedly affect subsequent imaging utilization and the degree of diagnostic errors.”
They call for future studies with “more homogeneous datasets in terms of POCUS operators” to gauge the generalizability of their findings.
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Reference:
1. Sabine Heinz, Derya Yakar, Rudi A.J.O. Dierckx, Thomas Kwee: “Point-of-care ultrasonography: downstream utilization of and diagnostic (dis)agreements with additional cross-sectional imaging.” European Journal of Radiology, May 5, 2022. DOI: https://doi.org/10.1016/j.ejrad.2022.110344
Dave P. has worked in journalism, marketing and public relations for more than 30 years, frequently concentrating on hospitals, healthcare technology and Catholic communications. He has also specialized in fundraising communications, ghostwriting for CEOs of local, national and global charities, nonprofits and foundations.