- 作者：P.C. Henwood ; J.S. Rempell ; A.S. Liteplo ; A.F. Murray ; D.C. Mackenzie ; M.M. Leo ; S. Vaillancourt ; E.R. Douglass ; D. Dukundane ; S. Rulisa ; A.J. Dean ; V.E. Noble
- 刊名：African Journal of Emergency Medicine
- 出版年：2013
- 出版时间：December, 2013
- 年：2013
- 卷：3
- 期：4_supp_S
- 页码：S5-S6
- 全文大小：64 K
Introduction
Point-of-care ultrasound (POCUS) is an effective diagnostic technology in resource-limited settings. There is increasing interest in introducing ultrasound training in such environments, but few reports describing long-term follow-up and impact of a POCUS program in a resource-limited setting. We introduced a POCUS program in Rwanda, and sought to determine the number and type of ultrasounds performed, the impact of a remote quality assurance (QA) program, and the effect of POCUS on patient management.Methods
Seventeen Rwandan physicians underwent a ten-day training course in POCUS in Kigali, Rwanda. Post-course, participants tracked the ultrasounds they performed using a cloud-based storage system, recorded clinical impressions, and received periodic QA with on-site proctoring over a six-month follow-up. Remote QA to evaluate image quality was performed by five emergency ultrasound fellowship-trained clinicians. Images were graded on a scale of 0-4. (0 = no meaningful image, 2 = adequate, 4 = outstanding). Trainees also documented how POCUS changed clinical management.
Results
Over six months, 1158 ultrasounds were performed and logged by fifteen participants at eleven regional hospitals. 590 (50.9 % ) had matched images and interpretations available for review. Abdominal ultrasound was the most frequently performed application (19.7 % ), followed by liver (14.6 % ), obstetrics (14.5 % ), renal (12.4 % ), and spleen (11 % ). Across all applications, the mean score was 2.5 (SD ¡À 0.11, 95 % confidence interval, 2.39-2.54). Ultrasound resulted in a management change in 84 % of cases. Major changes in management related to medication choice (42.4 % ), admission (30 % ), transfer to a higher level of care (28.1 % ), and performance of procedures (23.3 % ).
Conclusions
During this six-month training program in Rwanda, participants used POCUS for a range of applications. The remote QA process captured 51 % of ultrasounds performed. Of scans with QA, the average score was adequate to good. POCUS routinely changed clinical management. This study demonstrates the impact of POCUS in a resource-limited setting.