Public Release: 

Use of pocket-sized ultrasound device reduces need for further testing in clinical settings

Pocket-sized ultrasound device (PUD) use assists physicians in making more accurate diagnoses

European Association for the Study of the Liver

April 25, 2015, Vienna, Austria: Results from a study presented today at The International Liver Congress™ 2015 demonstrate that the use of a pocket-sized ultrasound device (PUD) helps to reduce the need for further testing in both the inpatient and outpatient setting.

The study evaluated the effectiveness of the PUD when testing for the following conditions: biliary-duct dilation, gallstones, ascites, splenomegaly, pleural effusion, pericardial effusion, urinary retention, urinary stones, abdominal mass and aortic aneurysm.

PUDs offer a comparable performance to standard ultrasonography, however the accuracy of a physical examination is often poor meaning that further tests are required. This study assessed whether adding the use of PUD to physical examination could lead to a reduction in the rate of additional tests.

Of the 1,962 patients included in the study:

  • 726 (37%) were inpatients, 510 (26%) were hepatology outpatients and 726 (37%) were recruited from GPs

  • Gallstones (37%), ascites - excessive accumulation of fluid in the abdominal cavity (17%), pleural effusion (13%), urinary stones (13%) and urinary retention (12%) accounted for more than 90% of the clinical questions, confirmed by PUD in 66% of cases

  • The overall frequency of further tests needed after PUD was 37%

  • The rate of agreement between findings of the PUD and additional tests was 89%

This study found that after basic training, the use of a PUD offers a simple and effective way to improve the accuracy of diagnosis and reduce the number of tests a patient needs.

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About The International Liver Congress™

This annual congress is the biggest event in the EASL calendar, attracting scientific and medical experts from around the world to learn about the latest in liver research. Specialists share research studies and findings, and discuss the hottest topics related to liver disease. This year, the congress is expected to attract approximately 10,000 delegates from all corners of the globe. 2015 is a very special year for EASL and the hepatology community as they will celebrate the 50th annual meeting. The International Liver Congress™ takes place from April 22-26, 2015, Vienna, Austria.

About EASL

Since EASL's foundation in 1966, this not-for-profit organisation has grown to over 4,000 members from more than 100 countries around the world. EASL is the leading liver association in Europe, it attracts the foremost hepatology experts and has an impressive track record in promoting research in liver disease, supporting wider education and promoting changes in European liver policy.

Contact

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EU and Public Health: Hall C (Plenary)
Presentation time: 11:45 - 12:00
Presenter: Agostino Colli (Italy)
Abstract O121: THE USE OF A POCKET-SIZED ULTRASOUND DEVICE IMPROVES PHYSICAL EXAMINATION: RESULTS OF AN IN- AND OUTPATIENT STUDY

THE USE OF A POCKET-SIZED ULTRASOUND DEVICE IMPROVES PHYSICAL EXAMINATION: RESULTS OF AN IN- AND OUTPATIENT STUDY

Agostino Colli* 1, Daniele Prati2, Mirella Fraquelli3, 4, Sergio Segato5, Pier Paolo Vescovi6, Fabrizio Colombo7, Carlo Balduini8, Alessandra Baccarin4, Serena Della Valle1, Dario Conte4, Giovanni Casazza9

1Department of Internal Medicine, Ospedale A. Manzoni , 2Department of Transfusion Medicine and Hematology, Ospedale A Manzoni , Lecco, 3Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Gastroenterology and Endoscopy Unit, 4Gastroenterology and Endoscopy Unit, Fondazione IRCCS Cà Granda Ospedale Maggiore Policlinico, Milano, Milano, 5Gastroenterology and GI Endoscopy, , Azienda Ospedaliero Universitaria Macchi, Varese, 6Division of Internal Medicine , Azienda Ospedaliera "Carlo Poma", 7Division of Internal Medicine, Azienda Ospedaliera Niguarda, Milano, 8Division of Internal Medicine, Fondazione IRCCS Policlinico San Matteo-Università degli Studi, Pavia, 9Deparment of Biomedical and Clinical Sciences, Università degli Studi di Milano, Milano, Italy

Background and Aims: The performance of pocket-sized ultrasound devices (PUDs) is comparable with that of standard ultrasonography, whereas the accuracy of a physical examination is often poor requiring further tests to assess diagnostic hypotheses. Adding the use of PUD to physical examination could lead to an incremental benefit. Accordingly, present cohort impact study was aimed at assessing whether the use of PUD in the context of physical examination could reduce the request rate of additional tests when used by physicians in different clinical settings.

Methods: The study involved medical wards(#4), hepatological outpatient clinic (#1) and 90 GPs operating in the same geographical area. After a short predefined training course 135 physicians used PUD in addition to physical examination in 1962 consecutive patients to investigate ten well-defined clinical hypotheses (biliary-duct dilation/ gallstones, ascites, splenomegaly, pleural /pericardial effusion, urinary retention/ stones, abdominal mass/ aortic aneurysm) . PUD related findings were recorded. and the decision as to whether to request further tests was left to the physician clinical judgement. The main outcome was to define the proportion of cases undergoing additional tests after PUD. An accurate report of the frequency of the clinical questions in the different settings was also planning , using logistic regression analysis to assess the determinant(s) of the primary outcome.

Results: Of the 1962 patients included 726 (37%) were inpatients, 510 (26%) hepatology outpatients and 726 (37%) recruited from GPs. Gallstones (37%), ascites (17%), pleural effusion (13%), urinary stones (13%) and urinary retention (12%) accounted for >90% of the clinical questions, confirmed by PUD in 66% of cases. The overall frequency of further tests after PUD was 37%; and logistic was associated with both the clinical questions and settings (p<0.01). The rate of agreement between findings at PUD and additional tests was 89%, with a sensitivity of 91% and a specificity of 83% ( LR+ 5.4; LR- 0.11).

Conclusions: After a simple and short training, a PUD examination can be used in addition to a physical examination in both in- and outpatients to improve the answer to ten common clinical questions, thus reducing the need further testing.

Disclosure of Interest: None Declared

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