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Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management

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Abstract

Background

Point of care ultrasound (POCUS) is a useful diagnostic tool in medicine. POCUS provides an easy and reproducible method of diagnosis where conventional radiologic studies are unavailable. Telemedicine is also a great means of communication between educators and students throughout the world.

Hypothesis

Implementing POCUS with didactics and hands-on training, using portable ultrasound devices followed by telecommunication training, will impact the differential diagnosis and patient management in a rural community outside the United States.

Materials and methods

This is an observational prospective study implementing POCUS in Las Salinas, a small village in rural western Nicaragua. Ultrasound was used to confirm a diagnosis based on clinical exam, or uncover a new, previously unknown diagnosis. The primary endpoint was a change in patient management. International sonographic instructors conducted didactic and practical training of local practitioners in POCUS, subsequently followed by remote guidance and telecommunication for 3 months.

Results

A total of 132 patients underwent ultrasound examination. The most common presentation was for a prenatal exam (23.5 %), followed by abdominal pain (17 %). Of the 132 patients, 69 (52 %) were found to have a new diagnosis. Excluding pregnancy, 67 patients of 101 (66 %) were found to have a new diagnosis. A change in management occurred in a total of 64 (48 %) patients, and 62 (61 %) after excluding pregnancy.

Conclusion

Implementing POCUS in rural Nicaragua led to a change in management in about half of the patients examined. With the appropriate training of clinicians, POCUS combined with telemedicine can positively impact patient care.

Sommario

Background

La diagnostica ecografica (POCUS) é un utile strumento diagnostico in medicina. Fornisce un metodo semplice e riproducibile di diagnosi, dove studi radiologici convenzionali non siano disponibili. Anche la telemedicina é un grande mezzo di comunicazione tra docenti e studenti di tutto il mondo.

Ipotesi

L’implementazione della POCUS con formazione didattica diretta, utilizzando ecografi portatili, seguita da una formazione attraverso la telecomunicazione, avrà un impatto nella diagnosi differenziale e nella gestione del paziente in una comunità rurale fuori degli Stati Uniti.

Materiali e Metodi

Presentiamo uno studio prospettico sull’implementazione della POCUS a Las Salinas, un piccolo villaggio rurale del Nicaragua occidentale. L’ecografia è stata utilizzata per confermare la diagnosi clinica, o per nuove diagnosi. Il punto primario era un cambiamento nella gestione del paziente. Istruttori internazionali hanno condotto una formazione didattica pratica locale, poi seguita da una guida a distanza con telecomunicazione, per tre mesi.

Risultati

Un totale di 132 pazienti sono stati sottoposti ad esame ecografico. L’esame più comune era per la diagnostica prenatale (23,5 %), seguito dal dolore addominale (17 %). Dei 132 pazienti, 69 (52 %) hanno avuto una nuova diagnosi. Nella diagnosi di esclusione di gravidanza 67 pazienti su 101 (66 %) hanno avuto una nuova diagnosi. Un cambiamento nella gestione si è verificato in un totale di 64 (48 %) pazienti, e in 62 (61 %) dopo aver escluso la gravidanza.

Conclusione

L’implementazione della POCUS nelle zone rurali del Nicaragua ha portato ad un cambiamento di gestione in circa la metà dei pazienti esaminati. Con la formazione adeguata dei medici, la POCUS, combinata con la telemedicina, può avere un impatto positivo nella cura del paziente.

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Conflict of interest

The authors on this manuscript have no disclosures or conflicts of interest.

Informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000. All patients provided written informed consent to enrollment in the study and to the inclusion in this article of information that could potentially lead to their identification.

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Authors and Affiliations

  1. Department of Surgery/Division of Trauma and Critical Care, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI, 48202, USA

    Nina Kolbe, Keith Killu, Victor Coba, Alberta Spreafico & Scott Dulchavsky

  2. Henry Ford Hospital, Ultrasound University, Detroit, MI, USA

    Keith Killu, Victor Coba, Luca Neri, Kathleen M. Garcia, Alberta Spreafico & Scott Dulchavsky

  3. World Interactive Network Focused on Critical Ultrasound, A. O. Niguarda Ca’ Granda Hospital, Milan, Italy

    Luca Neri & Alberta Spreafico

  4. Wyle Science, Technology and Engineering, El Segundo, CA, USA

    Kathleen M. Garcia & Scott Dulchavsky

  5. Houston Methodist Hospital, Houston, TX, USA

    Marti McCulloch

Authors
  1. Nina Kolbe
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  2. Keith Killu
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  3. Victor Coba
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  4. Luca Neri
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  5. Kathleen M. Garcia
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  6. Marti McCulloch
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  7. Alberta Spreafico
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  8. Scott Dulchavsky
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Corresponding author

Correspondence to Keith Killu.

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Kolbe, N., Killu, K., Coba, V. et al. Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management. J Ultrasound 18, 179–185 (2015). https://doi.org/10.1007/s40477-014-0126-1

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  • DOI: https://doi.org/10.1007/s40477-014-0126-1

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