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

• Published in: Journal of ultrasound 2015-06, Vol.18 (2), p.179-185
• Main Authors: Kolbe, Nina, Killu, Keith, Coba, Victor, Neri, Luca, Garcia, Kathleen M., McCulloch, Marti, Spreafico, Alberta, Dulchavsky, Scott
• Format: Article
• Language: English
• Subjects: Medicine; Medicine & Public Health; Original; Original Article; Ultrasound
• ISSN: 1971-3495; 1876-7931; 1876-7931
• DOI: 10.1007/s40477-014-0126-1

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.