Abstract:
Background
Point of care ultrasound (PoCUS) is an efficient, inexpensive, safe, and portable imaging
modality that can be particularly useful in resource-limited settings. However, its impact on
clinical decision making in such settings has not been well studied. The objective of this
study is to describe the utilization and impact of PoCUS on clinical decision making at an
urban emergency department in Dar es Salaam, Tanzania.
Methods
This was a prospective descriptive cross-sectional study of patients receiving PoCUS at
Muhimbili National Hospital's Emergency Medical Department (MNH EMD). Data on PoCUS
studies during a period of 10 months at MNH EMD was collected on consecutive patients during
periods when research assistants were available. Data collected included patient age
and sex, indications for ultrasound, findings, interpretations, and provider-reported diagnostic
impression and disposition plan before and after PoCUS. Descriptive statistics, including
medians and interquartile ranges, and counts and percentages, are reported. Pearson chi
squared tests and p-values were used to evaluate categorical data for significant differences.
Results
PoCUS data was collected for 986 studies performed on 784 patients. Median patient age
was 32 years; 56% of patients were male. Top indications for PoCUS included trauma,respiratory presentations, and abdomino-pelvic pain. The most frequent study types performed
were eFAST, cardiac, and obstetric or gynaecologic studies. Overall, clinicians
reported that the use of PoCUS changed either diagnostic impression or disposition plan in
29% of all cases. Rates of change in diagnostic impression or disposition plan increased to
45% in patients for whom more than one PoCUS study type was performed.
Conclusions
In resource-limited emergency care settings, PoCUS can be utilized for a wide range of indications
and has substantial impact on clinical decision making, especially when more than
one study type is performed.
