Utilization of Emergency Point of Care Ultrasound in an Emergency Department in Johannesburg

Stanton, Tamsyn B. B.
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Introduction Point-of-care ultrasound (PoCUS) is a widely utilized tool in Emergency Medicine (EM). The core PoCUS curriculum in South Africa (SA) does not currently include lung ultrasound or basic bedside echocardiography, although the burden of disease in a typical South African Emergency Department (ED) is skewed towards respiratory and cardiac pathologies. This study was undertaken to determine the profile of PoCUS examinations actually performed and potentially indicated in this ED, and whether current training in PoCUS is meeting the need in clinical practice. Methods This was a prospective observational audit of bedside PoCUS examinations actually performed, and potentially indicated, over a two-week period in the Helen Joseph Hospital ED in Johannesburg. Results The study included 372 patients. Ultrasound aided in the diagnosis and management of 107 (28,8%) of the patients. A total of 137 PoCUS investigations were performed. A total of 38,9% of the patients had positive ultrasound findings. The most frequently performed PoCUS applications were e-FAST (extended focused assessment by sonography in trauma) (32,8%), DVT assessment (13,9%) and procedural guidance (10,9%). A total of 758 PoCUS examinations were indicated in 307 (82,5%) of the patients. Overall, 18,1% of the potentially indicated PoCUS investigations were performed. The most frequently potentially indicated PoCUS applications were lung ultrasound (28,2%), basic cardiac (28%) and haemodynamic assessments (20,4%). Conclusions These findings reflect the high number of respiratory and cardiac cases seen in South African EDs. This highlights the consequent need for additional ultrasound skills to assist in the emergency management of such cases. Training of future South African EM specialist consultants should include both lung ultrasound and basic bedside echocardiography. It is time to update to the South African core PoCUS curriculum.
A research report submitted to the Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, in partial fulfilment of the requirements for the degree of Master of Medicine in Emergency Medicine, Johannesburg
Stranton, T. B. B. 2017. 2017. Utilization of emergency point of care ultrasound in an emergency department in Johannesburg. University of the Witwatersrand, Johannesburg.