TY - JOUR T1 - Point-of-care ultrasound for evaluation of vaginal bleeding or abdominal pain in early pregnancy JF - Canadian Family Physician JO - Can Fam Physician SP - e326 LP - e332 DO - 10.46747/cfp.6811e326 VL - 68 IS - 11 AU - Catherine E. Varner AU - Shirley Lee AU - Shelley McLeod AU - Erin Bearss AU - Amita Singwi AU - Shirley Hu AU - Negine Nahiddi AU - Bjug Borgundvaag Y1 - 2022/11/01 UR - http://www.cfp.ca/content/68/11/e326.abstract N2 - Objective To evaluate the use of point-of-care ultrasound (POCUS) for the assessment of patients experiencing first-trimester bleeding or abdominal pain by family physicians working in family medicine clinics following first-trimester POCUS training and certification.Design Multisite, retrospective chart review.Setting Two hospital-affiliated academic family medicine clinics in Toronto, Ont.Participants Twelve family physicians who completed a first-trimester POCUS training and certification course.Main outcome measures The primary outcome was the proportion of family physicians using POCUS during their evaluations of patients in the first trimester of pregnancy in the 6 months following the FPs’ successful completion of the Family Medicine Obstetrical Ultrasound (FaMOUS) course. Secondary outcomes included indications for POCUS use, diagnostic accuracy of POCUS compared with radiologist-interpreted ultrasound, pregnancy outcomes, and emergency department visits within 10 days of the index family medicine clinic visit.Results Of the 12 certified family physicians, 7 (58.3%) used POCUS during their assessments of first-trimester patients during the study period. The FPs used POCUS with 56 patients for the following indications: 11 (19.6%) had only vaginal bleeding, 5 (8.9%) had only abdominal pain, and 8 (14.3%) had both vaginal bleeding and abdominal pain; the indication for 32 patients (57.1%) was unclear. Forty-six patients (82.1%) underwent a subsequent radiologist-interpreted ultrasound within 10 days of the index POCUS test. Compared with radiologist-interpreted ultrasound, POCUS had a sensitivity of 91.3% (95% CI 79.2% to 97.6%) for documenting intrauterine pregnancy and a sensitivity of 81.4% (95% CI 66.6% to 91.6%) for documenting the presence of fetal cardiac activity.Conclusion Following a first-trimester POCUS certification course, family physicians used POCUS for the assessment of first-trimester patients with varying frequency and for indications other than vaginal bleeding or abdominal pain. Further study is needed to assess the clinical impact of office-based POCUS, unforeseen barriers and facilitators to its use, and patient and provider preferences. ER -