Change in differential diagnosis and patient management with the use of portable ultrasound in a remote setting

Michael Blaivas, Walter F Kuhn, Bradford Zahner Reynolds, Larry Brannam

Research output: Contribution to journalArticle

49 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)38-41
Number of pages4
JournalWilderness and Environmental Medicine
Volume16
Issue number1
DOIs
StatePublished - Jan 1 2005

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Differential Diagnosis
Physicians
Transducers
Oceans and Seas
Observational Studies
Decision Making
Therapeutics
Referral and Consultation
Prospective Studies
Kidney
Equipment and Supplies
Wounds and Injuries
Population
Surveys and Questionnaires

Keywords

  • Emergency medicine
  • Emergency ultrasound
  • Portable ultrasound
  • Remote setting
  • Rural medicine
  • Ultrasound

ASJC Scopus subject areas

  • Emergency Medicine
  • Public Health, Environmental and Occupational Health

Cite this

Change in differential diagnosis and patient management with the use of portable ultrasound in a remote setting. / Blaivas, Michael; Kuhn, Walter F; Reynolds, Bradford Zahner; Brannam, Larry.

In: Wilderness and Environmental Medicine, Vol. 16, No. 1, 01.01.2005, p. 38-41.

Research output: Contribution to journalArticle

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