Validation of Family Medicine Point-of-Care Ultrasound Screening (POCUS) for Abdominal Aortic Aneurysm.

Abstract

Ruptured abdominal aortic aneurysms (AAA) carry a mortality rate as high as 80% . Early detection through a screening ultrasound can lead to a large mortality reduction. Point-of-care ultrasound (POCUS) has preliminary data suggesting it is as accurate as hospital-based ultrasounds performed by a sonographer. This validation study investigated the relative concordance of family physicians using POCUS to determine aortic diameter compared with hospital-based ultrasound studies. The study was a cross-sectional, multi-observation study conducted at 3 office practices. Five family physicians with varying degrees of training and experience utilized various ultrasound machines to measure maximal aortic diameter at the proximal, mid, and distal aorta. Hospital-based ultrasound or Computed Tomography (CT) served as the validation scan. Pairwise comparisons were made, with statistical testing for difference using the T-TEST command with the PAIRS subcommand. Forty-four independent observations were completed by the 5 physicians on the 18 patients (n = 18). The mean difference between the POCUS and validation scans was 0.2 cm (95% CI -1.10 to 0.40). The family physicians generally underestimated the aortic diameter. The proximal aorta had the largest mean difference in aortic size (0.23 cm; <i>P</i> = .003). Type of ultrasound device used, the width of the largest aortic segment, and low patient body mass index had significant relations. This small study found data suggesting that family physicians with variable POCUS experience can accurately perform AAA screening in the ambulatory setting with either handheld or cart-based POCUS machines.