Evaluating the accuracy of point of care ultrasound scan in paediatric department at QECH
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Date
2022-03-22
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Kamuzu University of Health Sciences
Abstract
Background
Point of care ultrasound (POCUS) is a low cost, highly effective tool that significantly augments physical
examination in making timely diagnosis of acute illness as well as guiding resuscitations and invasive
procedures.(1, 2) The exam is focused, goal directed, and quickly performed at the bedside, in order to
improve the patient's outcome. (3) However, it is highly operator and equipment dependent which
carries implications about its use in guiding moment-to-moment therapeutic decisions when used in a
point-of-care context. (4)
In recent years there has been an increasing effort to integrate POCUS into clinical care provided in
resource-limited settings. (5) Previous studies have demonstrated that physicians can perform effective
and accurate scans after as little as 3 hours of didactic training and 5 hours of hands on training with an
increase in confidence in use of POCUS with short and focused periodic re-training. (2, 6) There is
growing evidence showing the impact of POCUS use in resource limited settings in aiding diagnosis,
clinical management of patients and health care cost saving. (7,8).
In 2018 a training program on POCUS was initiated in the Department of Medicine at the University of
Malawi, College of Medicine, in cooperation with the University of Hamburg. An evaluation of the
implementation and practice of the program showed that POCUS relieved the burden of radiologistperformed ultrasound by half and 78% pf POCUS examination conducted had an impact on patient
management. (8) In recent years, POCUS training has been incorporated into residency training
programs worldwide. In north America, the adoption of the use of POCUS has been progressively
increased within paediatric residency training programs from 65% in 2006 to 95% in 2011.(9) Though
there are many known benefits relating to the use of POCUS in general paediatric patients, there are
limited studies that demonstrate the accuracy of POCUS when comparing non radiologist to radiologistperformed ultrasound examinations in paediatrics in the resource limited setting.
The incidence of hydrocephalus is highest in Africa with an estimated annual incidence of more than
225,000 new cases of infant hydrocephalus. (10) The main imaging modality of diagnosis in resource
limited setting where access to Computed Tomography is limited, is ultrasonography. There is
anecdotally however an approximate average waiting time of 7 days for an ultrasound to confirm this
diagnosis at QECH in elective patients. This delay can potentially be reduced by use of POCUS which
would aid in a quicker diagnosis and more prompt referral for neurosurgical intervention in certain
cases