Implementation of a smartphone-based ultrasound program to improve timely diagnosis of life-threatening injuries in Cameroon: Results from a prospective, multisite feasibility study.

Abstract

Undiagnosed hemorrhage is the leading cause of preventable trauma death in Cameroon, yet few injured patients receive imaging to diagnose hemorrhage. A smartphone-based ultrasonography (SBU) curriculum was developed to rapidly train frontline healthcare providers in Cameroon to perform and interpret eFAST. SBU has demonstrated promising educational efficacy, but its clinical feasibility in this technology-constrained setting is unknown. We evaluate the feasibility and acceptability of a SBU pilot at three trauma centers in Cameroon. We implemented a six-month feasibility pilot at three Cameroonian hospitals participating in the Cameroon Trauma Registry (CTR). Trauma providers were trained to perform SBU eFAST using a novel 5-hour curriculum, then asked to perform SBU on all injured patients as part of the trauma evaluation. Feasibility was assessed as the proportion of CTR patients with completed eFAST. Acceptability was assessed as the proportion of users rating SBU ≥ 68 on the previously validated System Usability Scale (SUS). Trauma care providers completed SBU eFAST on 87% (608 of 701) of eligible patients, compared to a pre-study diagnostic imaging rate of 5.5% (38 of 648). Completion was highest at the rural and regional low-volume centers (100%, n = 42 and n = 75, respectively) and lower at the high-volume urban tertiary referral center (84%, n = 491, p < 0.01). Overall, 88.9% (n = 24/27) of providers rated SBU usable (SUS ≥68) at 2 months, which improved to 100% (12/12) at 6 months. Implementation of a SBU program is highly feasible and acceptable in Cameroon, with an associated 81% increase in diagnostic imaging among trauma registry patients. A multisite prospective clinical trial is planned to assess the impact of SBU on patient outcomes, including preventable trauma deaths.