RT Journal Article
SR Electronic
T1 Point-of-care ultrasound for evaluation of vaginal bleeding or abdominal pain in early pregnancy
JF Canadian Family Physician
JO Can Fam Physician
FD The College of Family Physicians of Canada
SP e326
OP e332
DO 10.46747/cfp.6811e326
VO 68
IS 11
A1 Catherine E. Varner
A1 Shirley Lee
A1 Shelley McLeod
A1 Erin Bearss
A1 Amita Singwi
A1 Shirley Hu
A1 Negine Nahiddi
A1 Bjug Borgundvaag
YR 2022
UL http://www.cfp.ca/content/68/11/e326.abstract
AB 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.