The reliability of Point-of-Care ultrasound examination of the lung in primary care performed by general practitioners

David Halata, Dusan Zhor, Roman Skulec

Keywords: primary care; Point-of-Care ultrasound; lung examination; reliability; covid-19

Background:

The implementation of Point-of-Care ultrasound (POCUS) performed by GPs has the potential to increase diagnostic certainty and expedite the diagnosis of certain diseases. While there is abundant experience and data from other specialties, there is currently a lack of scientific data on the reliability of POCUS performed by GPs.

Research questions:

What is the reliability of diagnosing certain diseases using POCUS performed by GPs?

Method:

We recruited 17 GPs from various regions of the Czech Republic. They underwent a one-day educational course on lung POCUS. All patients with current dyspnea (NYHA II-IV) or a history of dyspnea in the last 4 weeks were indicated for the POCUS diagnosis of pleural effusion and alveolo-interstitial syndrome. Considering the varying sensitivity and specificity of different reference examinations and the POCUS itself, an independent expert sonographer performed subsequent evaluation of the examinations using recorded video loops as the reference criterion.

Results:

A 128 patients were enrolled in the study. A total of 768 thoracic segments were examined. An A profile was identified in 642 (83.6%) segments, a B profile in 108 (14.1%), pulmonary consolidation in 8 (1.0%), and pleural effusion in 12 (1.6%). For the identification of an A profile, the sensitivity was 97.51% and the specificity was 88.10%, a B profile, the sensitivity was 87.04% and the specificity was 97.73%, pulmonary consolidation showed a sensitivity of 100.0% and specificity of 100.0%, for pleural effusion, the sensitivity was 83.33% and specificity was 99.87%.

Conclusions:

The study confirmed, within the given patient cohort, that GPs after a brief training are capable of performing lung ultrasound examinations with a high level of reliability compared to expert assessment. The use of POCUS for pleural and lung examinations, along with other Point-of-Care testing methods, brings the opportunity to diagnose pulmonary pathologies in Primary Care without unnecessary delays or the need for patient transportation.

Points for discussion:

POCUS curriculum for GPs

POCUS lung examination vs X-rays lung examination

Role of the POCUS in Primary Care

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