Shaddock Liam, Smith Tony
Medical Radiation Science, School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia.
The University of Newcastle Department of Rural Health & School of Health Sciences, The University of Newcastle, Newcastle, New South Wales, Australia.
J Multidiscip Healthc. 2022 Mar 29;15:605-625. doi: 10.2147/JMDH.S359084. eCollection 2022.
Point of care ultrasound (POCUS) has become more common for rapid evaluation. Applications are limited by lack of training of users, difficulty maintaining ultrasound competencies, access to equipment for optimal imaging, and limitations in quality control. Such barriers exist in low-resource, underserved health care settings.
The aim was to explore the use of POCUS in under-resourced health care settings, such as rural and remote locations in Australia and other countries. Key variables include health outcomes, quality of care, service availability, examinations types performed, equipment used, who performs the examinations, and the ultrasound training received.
Literature was identified via CINAHL, Cochrane, Embase, Medline, PubMed, SCOPUS, and Web of Science, plus grey literature. Recommended guidelines were followed, and only research-based articles were included, with searches limited to English language and 2010-present.
After screening, 23 articles were reviewed. No studies had low risk of bias and, overall, the quality was poor and only two studies used random sampling. The majority were from developing countries, with only one performed in Australia. Echocardiographic screening in schools was common. Others included emergency department (ED) patients, abdominal aorta screening, obstetric scans, and intensive care unit (ICU) management. Operators included ED doctors, medical students, nurses, community healthcare workers and general practitioners, who received limited training in protocol-driven scanning, often monitored by experts. In comparison to clinical assessment, standard ultrasound or other imaging, accuracy was of the order of 70-95%, depending on the condition, with high efficacy in improving patient care.
Lack of studies of POCUS in Australia and other developed countries suggests a need for further research. Current evidence supports use of limited ultrasound using portable machines in locations with limited access to diagnostic ultrasound performed by sonographers, which has the potential to improve health outcomes in under-resourced communities in Australia and elsewhere.
床旁超声检查（POCUS）在快速评估中变得越来越普遍。其应用受到用户培训不足、难以维持超声技能、获取用于优化成像的设备以及质量控制方面的限制等因素的制约。这些障碍在资源匮乏、医疗服务不足的环境中也存在。
旨在探索POCUS在资源匮乏的医疗环境中的应用，例如澳大利亚和其他国家的农村和偏远地区。关键变量包括健康结果、护理质量、服务可用性、所进行的检查类型、使用的设备、进行检查的人员以及接受的超声培训。
通过CINAHL、Cochrane、Embase、Medline、PubMed、SCOPUS和Web of Science以及灰色文献来识别文献。遵循推荐的指南，仅纳入基于研究的文章，搜索限于英语且时间范围为2010年至今。
筛选后，对23篇文章进行了综述。没有研究存在低偏倚风险，总体质量较差，只有两项研究采用了随机抽样。大多数研究来自发展中国家，只有一项在澳大利亚进行。在学校进行超声心动图筛查很常见。其他研究包括急诊科患者、腹主动脉筛查、产科扫描以及重症监护病房（ICU）管理。操作人员包括急诊科医生、医学生、护士、社区医护人员和全科医生，他们在协议驱动扫描方面接受的培训有限，通常由专家进行监督。与临床评估、标准超声或其他成像相比，根据具体情况，准确性约为70 - 95%，在改善患者护理方面具有较高的效能。
在澳大利亚和其他发达国家缺乏对POCUS的研究表明需要进一步开展研究。目前的证据支持在超声诊断技师难以提供诊断超声服务的地区使用便携式机器进行有限的超声检查，这有可能改善澳大利亚及其他地区资源匮乏社区的健康结果。
