Download PDF
CC BY-NC-ND 4.0 · Ultrasound Int Open 2024; 10: a21961599
DOI: 10.1055/a-2196-1599
Original Article

Bedside Clinical Hand-held Ultrasound in an Internal Medicine Department: The "Bed Med-Us" Experience of Codogno and its Clinical Utility in the Management of Diagnosis and Therapy in 1007 Patients

Francesco Giangregorio 
1   Internal Medicine, Codogno Hospital, Codogno, Italy
,
Emilio Mosconi
1   Internal Medicine, Codogno Hospital, Codogno, Italy
,
Maria Grazia Debellis
1   Internal Medicine, Codogno Hospital, Codogno, Italy
,
Eliana Palermo
1   Internal Medicine, Codogno Hospital, Codogno, Italy
,
Stella Provini
1   Internal Medicine, Codogno Hospital, Codogno, Italy
,
Manuela Mendozza
1   Internal Medicine, Codogno Hospital, Codogno, Italy
,
Laura Ricevuti
1   Internal Medicine, Codogno Hospital, Codogno, Italy
,
Ciro Esposito
1   Internal Medicine, Codogno Hospital, Codogno, Italy
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Abstract

Purpose Handheld ultrasound (HH-US) answers simple clinical questions in emergencies. We performed conventional US with HH-US at the patient’s bedside (BED) during a medical visit (MED) (BED MED-US). The purpose of this prospective study is to estimate BED MED-US reliability, its clinical impact in helping the clinician to formulate correct diagnoses, and its ability to save time and money.

Materials and Methods 1007 patients (519 M; age:76.42) were assessed (from March 2021 to November 2022) in one or more districts. Final diagnosis was determined with clinical and reference tests (chest RX/CT, abdominal CT, endoscopy, etc.). Sensitivity, specificity, LR+ and LR-, and corresponding AUROC were evaluated. HH-US diagnoses were classified as: confirmation (HH-US revealed the sonographic signs that confirmed the clinical diagnosis) (CO), exclusion (HH-US excluded the presence of the ultrasound signs of other pathologies, in the clinical differential diagnosis) (EX), etiological (HH-US reaches diagnosis in clinically doubtful cases) (ET), or clinically relevant incidental (HH-US diagnoses that change the patient's process completely) (INC).

Results HH-US reliability: true-pos: 752; true-neg: 242; false-pos: 7; false-neg: 6 (sens: 99.1%, spec: 97.6%, LR+: 98.5; LR-: 00.15, AUROC: 0.997); clinical impact: CO-diagnosis: 21%; EX: 25%; ET: 47%; INC: 7%; saved time and money: approximately 35,572 minutes of work and 9324 euros.

Conclusion BED MED-US is a reliable clinical imaging system, with an important clinical impact both in diagnosis (etiological in 47%, incidental in 7%) and in the management of personnel resources.

Key words

internal medicine - BED MED-US - point-of-care ultrasound - multi-site ultrasound - handheld ultrasound


Publication History

Received: 29 May 2023

Accepted after revision: 22 October 2023

Article published online:
05 January 2024

© 2024. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial-License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/).

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

Bibliographical Record
Francesco Giangregorio, Emilio Mosconi, Maria Grazia Debellis, Eliana Palermo, Stella Provini, Manuela Mendozza, Laura Ricevuti, Ciro Esposito. Bedside Clinical Hand-held Ultrasound in an Internal Medicine Department: The "Bed Med-Us" Experience of Codogno and its Clinical Utility in the Management of Diagnosis and Therapy in 1007 Patients. Ultrasound Int Open 2024; 10: a21961599.
DOI: 10.1055/a-2196-1599
 

  • References

  • 1 Diaz-Gomez JL, Mayo PH, Koenig SJ. Point-of-Care Ultrasonography. N Engl J Med 2021; 385: 1593-1602
    Search in Google Scholar
  • 2 Shaddock L, Smith T. Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review. J Multidiscip Healthc 2022; 15: 605-625
    Search in Google Scholar
  • 3 Elder AT, McManus IC, Patrick A. et al. The value of the physical examination in clinical practice: an international survey. Clin Med (Lond) 2017; 17: 490-498
    Search in Google Scholar
  • 4 [Anonym]. The Centennial of the Stethoscope. JAMA 2016; 315: 2738
    Search in Google Scholar
  • 5 Lopez-Palmero S, Bolivar-Herrera N, Lopez-Lloret G. et al. Diagnostic utility of handheld ultrasonography as an extension of the physical examination of patients with heart failure. Revista clinica espanola 2015; 215: 204-210
    Search in Google Scholar
  • 6 Kimura BJ, Shaw DJ, Amundson SA. et al. Cardiac Limited Ultrasound Examination Techniques to Augment the Bedside Cardiac Physical Examination. J Ultrasound Med 2015; 34: 1683-1690
    Search in Google Scholar
  • 7 Kimura BJ. Point-of-care cardiac ultrasound techniques in the physical examination: better at the bedside. Heart 2017; 103: 987-994
    Search in Google Scholar
  • 8 Rykkje A, Carlsen JF, Nielsen MB. Hand-Held Ultrasound Devices Compared with High-End Ultrasound Systems: A Systematic Review. Diagnostics (Basel) 2019; 9: 61
    Search in Google Scholar
  • 9 Duminuco A, Cupri A, Massimino R. et al. Handheld Ultrasound or Conventional Ultrasound Devices in Patients Undergoing HCT: A Validation Study. J Clin Med 2023; 12: 520
    Search in Google Scholar
  • 10 Menten J, Lesaffre E. A general framework for comparative Bayesian meta-analysis of diagnostic studies. BMC Med Res Methodol 2015; 15: 70
    Search in Google Scholar
  • 11 Newcombe RG. Two-sided confidence intervals for the single proportion: comparison of seven methods. Statistics in medicine 1998; 17: 857-872
    Search in Google Scholar
  • 12 Kirkpatrick C, Evans R, Parker P. et al. Incidental Findings on General Medical Ultrasound (US) Examinations. In: British Medical Ultrasound Society (BMUS). third Edition ed https://www.bmus.org/policies-statements-guidelines/professional-guidance/guidance-pages/incidental-findings-/: British Medical Ultrasound Society (BMUS) 2021; 38
  • 13 INDEED. A quanto ammonta uno stipendio da Oss (Brescia, Lombardia)? In Internet https://it.indeed.com/career/oss/salaries/Brescia--Lombardia
  • 14 Watkins MW. An EXCEL program for calculating and graphing the Receiver Operating Characteristic (ROC) [Computer software]. State College, PA: Ed & Psych Associates; 2000
    Search in Google Scholar
  • 15 Dietrich CF, Goudie A, Chiorean L. et al. Point of Care Ultrasound: A WFUMB Position Paper. Ultrasound Med Biol 2016;
    Search in Google Scholar
  • 16 Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest 2008; 134: 117-125
    Search in Google Scholar
  • 17 Scalea TM, Rodriguez A, Chiu WC. et al. Focused Assessment with Sonography for Trauma (FAST): results from an international consensus conference. J Trauma 1999; 46: 466-472
    Search in Google Scholar
  • 18 Perera P, Mailhot T, Riley D. et al. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically lll. Emerg Med Clin North Am 2010; 28: 29-56, vii
    Search in Google Scholar
  • 19 Weingarten SD, Duque D, Nelson B. The RUSH exam: Rapid Ultrasound for Shock and Hypotension. In: EMCrit website:. 2016
  • 20 Kimura BJ, Shaw DJ, Agan DL. et al. Value of a cardiovascular limited ultrasound examination using a hand-carried ultrasound device on clinical management in an outpatient medical clinic. Am J Cardiol 2007; 100: 321-325
    Search in Google Scholar
  • 21 Koch C, Roberts K, Petruccelli C. et al. The Frequency of Unnecessary Testing in Hospitalized Patients. Am J Med 2018; 131: 500-503
    Search in Google Scholar
  • 22 Zanobetti M, Scorpiniti M, Gigli C. et al. Point-of-Care Ultrasonography for Evaluation of Acute Dyspnea in the ED. Chest 2017; 151: 1295-1301
    Search in Google Scholar
  • 23 Gaber HR, Mahmoud MI, Carnell J. et al. Diagnostic accuracy and temporal impact of ultrasound in patients with dyspnea admitted to the emergency department. Clin Exp Emerg Med 2019; 6: 226-234
    Search in Google Scholar
  • 24 Dalen JE. Cardiac Examination: Stethoscope or Pocket Echo-Why Not Both?. Am J Med 2016; 129: 649-650
    Search in Google Scholar
  • 25 Mozzini C, Di Dio Perna M, Pesce G. et al. Lung ultrasound in internal medicine efficiently drives the management of patients with heart failure and speeds up the discharge time. Intern Emerg Med 2018; 13: 27-33
    Search in Google Scholar
  • 26 Perrone T, Maggi A, Sgarlata C. et al. Lung ultrasound in internal medicine: A bedside help to increase accuracy in the diagnosis of dyspnea. European journal of internal medicine 2017; 46: 61-65
    Search in Google Scholar
  • 27 Price S, Platz E, Cullen L. et al. Expert consensus document: Echocardiography and lung ultrasonography for the assessment and management of acute heart failure. Nat Rev Cardiol 2017; 14: 427-440
    Search in Google Scholar
  • 28 Mancusi C, Carlino MV, Sforza A. Point-of-care ultrasound with pocket-size devices in emergency department. Echocardiography 2019; 36: 1755-1764
    Search in Google Scholar
  • 29 Narasimhan M, Koenig SJ, Mayo PH. A Whole-Body Approach to Point of Care Ultrasound. Chest 2016; 150: 772-776
    Search in Google Scholar
  • 30 Barchiesi M, Bulgheroni M, Federici C. et al. Impact of point of care ultrasound on the number of diagnostic examinations in elderly patients admitted to an internal medicine ward. European journal of internal medicine 2020; 79: 88-92
    Search in Google Scholar
  • 31 Haji-Hassan M, Lenghel LM, Bolboaca SD. Hand-Held Ultrasound of the Lung: A Systematic Review. Diagnostics (Basel) 2021; 11: 1381
    Search in Google Scholar
  • 32 Buda N, Kosiak W, Welnicki M. et al. Recommendations for Lung Ultrasound in Internal Medicine. Diagnostics 2020; 10: 597
    Search in Google Scholar
  • 33 Bots S, De Voogd F, De Jong M. et al. Point-of-care intestinal ultrasound in IBD patients: disease management and diagnostic yield in a real-world cohort and proposal of a point-of-care algorithm. Journal of Crohn̓s & Colitis 2022; 16: 606-615
    Search in Google Scholar
  • 34 Costantino A, Piagnani A, Nandi N. et al. Reproducibility and diagnostic accuracy of pocket-sized ultrasound devices in ruling out compensated cirrhosis of mixed etiology. Eur Radiol 2022; 32: 4609-4615
    Search in Google Scholar
  • 35 Rispo A, Calabrese G, Testa A. et al. Hocus Pocus: the Role of Hand-held Ultrasonography in Predicting Disease Extension and Endoscopic Activity in Ulcerative Colitis. Journal of Crohn's & colitis 2023; 17: 1089-1096
    Search in Google Scholar
  • 36 Rispo A, de Sire R, Mainenti PP. et al. David Against Goliath: Direct Comparison of Handheld Bowel Sonography and Magnetic Resonance Enterography for Diagnosis of Crohn's Disease. Inflamm Bowel Dis 2023; 29: 563-569
    Search in Google Scholar
  • 37 Moussaoui G, Zakaria AS, Negrean C. et al. Accuracy of Clarius, Handheld Wireless Point-of-Care Ultrasound, in Evaluating Prostate Morphology and Volume Compared to Radical Prostatectomy Specimen Weight: Is There a Difference between Transabdominal vs Transrectal Approach?. J Endourol 2021; 35: 1300-1306
    Search in Google Scholar
  • 38 Galindo P, Gasca C, Argaiz ER. et al. Point of care venous Doppler ultrasound: Exploring the missing piece of bedside hemodynamic assessment. World J Crit Care Med 2021; 10: 310-322
    Search in Google Scholar
  • 39 Frohlich E, Beller K, Muller R. et al. Point of Care Ultrasound in Geriatric Patients: Prospective Evaluation of a Portable Handheld Ultrasound Device. Ultraschall in Med 2020; 41: 308-316
    Search in Google Scholar
  • 40 Musolino AM, Buonsenso D, Massolo AC. et al. Point of care ultrasound in the paediatric acute care setting: Getting to the 'heart' of respiratory distress. J Paediatr Child Health 2021; 57: 318-322
    Search in Google Scholar
  • 41 Gupta A, Kindarara DM, Chun KC. et al. Accuracy of Point-of-Care Ultrasound in Follow Up Abdominal Aortic Aneurysm Imaging. Vascular and endovascular surgery 2022; 15385744221099093
    Search in Google Scholar
  • 42 Vilanova-Rotllan S, Kostov B, Giner Martos MJ. et al. Feasibility study of abdominal ultrasound using hand-held devices in homecare services. Medicina clinica 2022; 158: 361-365
    Search in Google Scholar
  • 43 Rosborough TK, Becker JS, Desautels CN. et al. An Ultrasound Screening Exam During Medicare Wellness Visits May Be Beneficial. J Ultrasound Med 2022; 41: 1069-1076
    Search in Google Scholar
  • 44 Lo H, Eder N, Boten D. et al. Handheld Ultrasound (HHUS): Potential for Home Palliative Care. Ultrasound Int Open 2022; 8: E68-E76
    Search in Google Scholar
  • 45 Nielsen MB, Cantisani V, Sidhu PS. et al. The Use of Handheld Ultrasound Devices - An EFSUMB Position Paper. Ultraschall Med 2019; 40: 30-39
    Search in Google Scholar
  • 46 [Anonym]. AIUM Practice Parameter for the Performance of Point-of-Care Ultrasound Examinations. J Ultrasound Med 2019; 38: 833-849
    Search in Google Scholar
  • 47 Grgurevic I, Tjesic Drinkovic I, Pinzani M. Multiparametric ultrasound in liver diseases: an overview for the practising clinician. Postgraduate medical journal 2019; 95: 425-432
    Search in Google Scholar
  • 48 Puca P, Del Vecchio LE, Ainora ME. et al. Role of Multiparametric Intestinal Ultrasound in the Evaluation of Response to Biologic Therapy in Adults with Crohn's Disease. Diagnostics (Basel) 2022; 12: 1991
    Search in Google Scholar
  • 49 Jager A, Postema AW, Mischi M. et al. Clinical Trial Protocol: Developing an Image Classification Algorithm for Prostate Cancer Diagnosis on Three-dimensional Multiparametric Transrectal Ultrasound. Eur Urol Open Sci 2023; 49: 32-43
    Search in Google Scholar
  • 50 Casado-Lopez I, Tung-Chen Y, Torres-Arrese M. et al. Usefulness of Multi-Organ Point-of-Care Ultrasound as a Complement to the Decision-Making Process in Internal Medicine. J Clin Med 2022; 11: 2256
    Search in Google Scholar
  • 51 Cid-Serra X, Hoang W, El-Ansary D. et al. Clinical Impact of Point-of-Care Ultrasound in Internal Medicine Inpatients: A Systematic Review. Ultrasound Med Biol 2022; 48: 170-179
    Search in Google Scholar
  • 52 Cid-Serra X, Royse A, Canty D. et al. Clinical relevance of a multiorgan focused clinical ultrasound in internal medicine. Ultrasound J 2022; 14: 16
    Search in Google Scholar
  • 53 Radonjic T, Popovic M, Zdravkovic M. et al. Point-of-Care Abdominal Ultrasonography (POCUS) on the Way to the Right and Rapid Diagnosis. Diagnostics (Basel) 2022; 12: 2052
    Search in Google Scholar
  • 54 Denault A, Canty D, Azzam M. et al. Whole body ultrasound in the operating room and intensive care unit. Kor J Anesthesiol 2019; 72: 413-428
    Search in Google Scholar
  • 55 Lucas BP, Tierney DM, Jensen TP. et al. Credentialing of Hospitalists in Ultrasound-Guided Bedside Procedures: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2018; 13: 117-125
    Search in Google Scholar
  • 56 O'Sullivan JW, Muntinga T, Grigg S. et al. Prevalence and outcomes of incidental imaging findings: umbrella review. BMJ 2018; 361: k2387
    Search in Google Scholar
  • 57 Koo MM, Rubin G, McPhail S. et al. Incidentally diagnosed cancer and commonly preceding clinical scenarios: a cross-sectional descriptive analysis of English audit data. BMJ open 2019; 9: e028362
    Search in Google Scholar
  • 58 Torres-Macho J, Aro T, Bruckner I. et al. Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine. European journal of internal medicine 2020; 73: 67-71
    Search in Google Scholar
  • 59 Ma IWY, Arishenkoff S, Wiseman J. et al. Internal Medicine Point-of-Care Ultrasound Curriculum: Consensus Recommendations from the Canadian Internal Medicine Ultrasound (CIMUS) Group. Journal of general internal medicine 2017; 32: 1052-1057
    Search in Google Scholar
  • 60 Soni NJ, Schnobrich D, Mathews BK. et al. Point-of-Care Ultrasound for Hospitalists: A Position Statement of the Society of Hospital Medicine. J Hosp Med 2019; 14: E1-E6
    Search in Google Scholar
  • 61 Neri L, Storti E, Lichtenstein D. Toward an ultrasound curriculum for critical care medicine. Crit Care Med 2007; 35: S290-304
    Search in Google Scholar