Point of Care Ultrasound in Geriatric Patients: Prospective Evaluation of a Portable Handheld Ultrasound Device

Abstract

Purpose The aim of the current study was to evaluate point of care ultrasound (POCUS) in geriatric patients by echoscopy using a handheld ultrasound device (HHUSD, VScan) at bedside in comparison to a high-end ultrasound system (HEUS) as the gold standard.

Materials and Methods Prospective observational study with a total of 112 geriatric patients. The ultrasound examinations were independently performed by two experienced blinded examiners with a portable handheld device and a high-end ultrasound device. The findings were compared with respect to diagnostic findings and therapeutic implications.

Results The main indications for the ultrasound examinations were dyspnea (44.6 %), fall (frailty) (24.1 %) and fever (21.4 %). The most frequently found diagnoses were cystic lesions 32.1 % (35/109), hepatic vein congestion 19.3 % (21/109) and ascites 13.6 % (15/110). HHUSD delivered 13 false-negative findings in the abdomen resulting in an “overall sensitivity” of 89.5 %. The respective “overall specificity” was 99.6 % (7 false-positive diagnoses). HHUSD (versus HEUS data) resulted in 13.6 % (17.3 %) diagnostically relevant procedures in the abdomen and 0.9 % (0.9 %) in the thorax. Without HHUSD (HEUS) 95.7 % (100 %) of important pathological findings would have been missed.

Conclusion The small HHUSD tool improves clinical decision-making in immobile geriatric patients at the point of care (geriatric ward). In most cases, HHUSD allows sufficiently accurate yes/no diagnoses already at the bedside, thereby clarifying the leading symptoms for early clinical decision-making.

Zusammenfassung

Einleitung Ziel der aktuellen Studie war es, bei bettlägerigen geriatrischen Patienten den Point-of-Care-Ultraschall (POCUS) mit einem portablen Ultraschallgerät im Taschenformat (HHUSD, VScan) mit einem High-End-Ultraschallsystem (HEUS) als Goldstandard zu vergleichen und zu bewerten.

Material und Methoden Prospektive Beobachtungsstudie mit insgesamt 112 geriatrischen Patienten. Die Ultraschalluntersuchungen wurden unabhängig voneinander von 2 erfahrenen verblindeten Prüfern an einem tragbaren Handgerät (Vscan, 2. Generation) und einem stationären High-End-Ultraschallgerät (GE Logiq S7 Expert) durchgeführt. Die Ergebnisse wurden hinsichtlich diagnostisch relevanter Befunde und therapeutischer Implikationen verglichen.

Ergebnisse Hauptindikationen für die Ultraschalluntersuchungen waren Dyspnoe (44,6 %), Sturz (Gebrechlichkeit) (24,1 %) und Fieber (21,4 %). Die häufigsten gefundenen Diagnosen waren zystische Läsionen (32,1 %; 35/109), Stauung der Lebervenen (19,3 %; 21/109) und Aszites (13,6 %; 15/110). Bezogen auf alle gefundenen abdominalen Diagnosen (n = 124) lieferte HHUSD 13 falsch negative Befunde mit einer „Gesamtsensitivität“ von 89,5 %. Die „Gesamtspezifität“ betrug 99,6 % (7 falsch positive Diagnosen). HHUSD (im Vergleich zu HEUS-Daten) ergab bei 13,6 % (17,3 %) Befunde mit diagnostischer Konsequenz im Abdomen und 0,9 % (0,9 %) im Thorax. Ohne HHUSD (HEUS) wären 95,7 % (100 %) wichtige pathologische Befunde nicht erkannt worden.

Diskussion Das kleine HHUSD verbessert die klinische Entscheidungsfindung bei geriatrischen Patienten. In den meisten Fällen erlaubt HHUSD bereits am Krankenbett hinreichend genaue Ja/Nein-Diagnosen, um symptombezogen schnelle klinische Entscheidungen zu treffen.

Key words

point of care - guideline - frailty - ascites - pleural effusion

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