Browsing by Author "Wanda, Watipaso"

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    Evaluating the accuracy of point of care ultrasound scan in paediatric department at QECH
    (Kamuzu University of Health Sciences, 2022-03-22) Wanda, Watipaso
    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