Cid-Serra Ximena, Gibbs Harry, Szecket Nicolas, Comeau Drew, Elliott Patrick, Duong Victor, Perera Padeepa, Thorson Peter, O'Donovan Ronan, Maguire Graeme, Hean Rattanak Visal, Potter Elizabeth
Department of General Medicine, The Royal Melbourne Hospital, Melbourne, Victoria, Australia.
Department of Surgery, University of Melbourne, Melbourne, Victoria, Australia.
Intern Med J. 2025 Jun 26. doi: 10.1111/imj.70127.
Point-of-care ultrasound (POCUS) complements physical examination to advance diagnosis and treatment in a range of clinical scenarios. However, the scope for adult internal medicine physicians is not defined in Australia and New Zealand.
To outline the clinical scope and core competencies of POCUS for internal medicine physicians in Australia and New Zealand using a consensus process.
A steering committee and expert panel utilised the Delphi method, comprising rounds of questionnaires and anonymous feedback, to define scope by determining (i) clinical scenarios in which POCUS provides benefit and (ii) core competencies in scanning. An 80% agreement cut-off was used in each round for both inclusion and exclusion of items, and items could be added depending on feedback. Synthesis of qualitative feedback was included.
The expert panel endorsed the use of POCUS in eight clinical scenarios: assessment of fluid status, undifferentiated shock or hypotension, dyspnoea/respiratory failure, acute kidney injury, suspected venous thromboembolism, synovitis/joint effusion and for guiding invasive procedures and diuretic therapy in heart failure. Core competencies based on identification of organ system pathology were endorsed, incorporating abnormalities of the heart, lung, inferior vena cava, abdomen, peripheral veins, soft tissue collection and joint effusion. The consensus intended not to mandate POCUS use nor limit the scope for physicians with advanced training, but offer a structured schema.
We successfully established a consensus on the POCUS scope for internal medicine in our region. This provides a foundation to develop formal training and credentialing.
床旁超声（POCUS）辅助体格检查，以促进一系列临床场景中的诊断和治疗。然而，在澳大利亚和新西兰，成人内科医生使用床旁超声的范围尚未明确。
通过共识流程概述澳大利亚和新西兰内科医生使用床旁超声的临床范围和核心能力。
一个指导委员会和专家小组采用德尔菲法，包括多轮问卷调查和匿名反馈，通过确定（i）床旁超声能发挥作用的临床场景，以及（ii）扫描的核心能力来界定范围。每一轮中，纳入和排除项目的同意率阈值均设定为80%，并可根据反馈增加项目。纳入了定性反馈的综合分析。
专家小组认可在八种临床场景中使用床旁超声：评估液体状态、不明原因的休克或低血压、呼吸困难/呼吸衰竭、急性肾损伤、疑似静脉血栓栓塞、滑膜炎/关节积液，以及在心力衰竭中指导侵入性操作和利尿治疗。基于器官系统病理识别的核心能力得到认可，包括心脏、肺、下腔静脉、腹部、外周静脉、软组织积液和关节积液的异常情况。该共识并非强制要求使用床旁超声，也不限制接受过高级培训的医生的范围，而是提供一个结构化的框架。
我们成功地就本地区内科床旁超声的范围达成了共识。这为开展正规培训和认证提供了基础。
