TY - JOUR
T1 - Change in differential diagnosis and patient management with the use of portable ultrasound in a remote setting
AU - Blaivas, Michael
AU - Kuhn, Walter F
AU - Reynolds, Bradford Zahner
AU - Brannam, Larry
PY - 2005
Y1 - 2005
N2 - Objective. - Physicians practicing in remote areas are typically limited in their choice of diagnostic tools. The goal of this study was to determine whether the use of a portable ultrasound (US) device on selected patients in a remote setting would alter physician diagnosis and management. Methods. - This was a prospective observational study of the affects of US on physician decision making deep in the Amazon jungle. A battery-operated Sonosite 180 Plus with 2 interchangeable transducers (4-7-MHz broadband intercavitary transducer and 2-5-MHz broadband abdominal transducer) was used. The patient population consisted of local tribal people. Two of the physicians on the team performed all US examinations. Team physicians requesting US examinations filled out a survey before and after the US examination. Before the US, the referring physician filled out a survey describing the patient's initial complaint, pertinent past medical history and physical findings, and an initial (pre-US) differential diagnosis and planned treatment with expected disposition. After the results of the US were reviewed with the referring physicians, the doctors were asked to fill out the remainder of the survey, allowing comparison of pre- and post-US differential diagnosis, treatment plan, and disposition. Results. - A total of 25 US studies were performed during this study (1 trauma US scan, 6 hepatobiliary studies, 5 transabdominal pelvic scans, 7 transvaginal pelvic studies, 3 renal studies, and 3 abdominal aortic scans). The monitor on the US unit experienced a rare failure shortly after being used at 17,000 ft and then 10 times at sea level, and no further US scans could be performed. US scan results dramatically altered the disposition of 7 patients, including 4 patients who avoided a potentially dangerous 2-day evacuation to more definitive medical care. Three patients were found to need rapid referral to the nearest clinic for surgical evaluation. Conclusions. - When used in a remote location, portable US provides a significant benefit that can dramatically alter disposition and treatment.
AB - Objective. - Physicians practicing in remote areas are typically limited in their choice of diagnostic tools. The goal of this study was to determine whether the use of a portable ultrasound (US) device on selected patients in a remote setting would alter physician diagnosis and management. Methods. - This was a prospective observational study of the affects of US on physician decision making deep in the Amazon jungle. A battery-operated Sonosite 180 Plus with 2 interchangeable transducers (4-7-MHz broadband intercavitary transducer and 2-5-MHz broadband abdominal transducer) was used. The patient population consisted of local tribal people. Two of the physicians on the team performed all US examinations. Team physicians requesting US examinations filled out a survey before and after the US examination. Before the US, the referring physician filled out a survey describing the patient's initial complaint, pertinent past medical history and physical findings, and an initial (pre-US) differential diagnosis and planned treatment with expected disposition. After the results of the US were reviewed with the referring physicians, the doctors were asked to fill out the remainder of the survey, allowing comparison of pre- and post-US differential diagnosis, treatment plan, and disposition. Results. - A total of 25 US studies were performed during this study (1 trauma US scan, 6 hepatobiliary studies, 5 transabdominal pelvic scans, 7 transvaginal pelvic studies, 3 renal studies, and 3 abdominal aortic scans). The monitor on the US unit experienced a rare failure shortly after being used at 17,000 ft and then 10 times at sea level, and no further US scans could be performed. US scan results dramatically altered the disposition of 7 patients, including 4 patients who avoided a potentially dangerous 2-day evacuation to more definitive medical care. Three patients were found to need rapid referral to the nearest clinic for surgical evaluation. Conclusions. - When used in a remote location, portable US provides a significant benefit that can dramatically alter disposition and treatment.
KW - Emergency medicine
KW - Emergency ultrasound
KW - Portable ultrasound
KW - Remote setting
KW - Rural medicine
KW - Ultrasound
UR - http://www.scopus.com/inward/record.url?scp=15744388934&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=15744388934&partnerID=8YFLogxK
U2 - 10.1580/1080-6032(2005)16[38:CIDDAP]2.0.CO;2
DO - 10.1580/1080-6032(2005)16[38:CIDDAP]2.0.CO;2
M3 - Article
C2 - 15813146
AN - SCOPUS:15744388934
SN - 1080-6032
VL - 16
SP - 38
EP - 41
JO - Wilderness and Environmental Medicine
JF - Wilderness and Environmental Medicine
IS - 1
ER -