Rural point-of-care ultrasound of the kidney and bladder: quality and effect on patient management
Garry Nixon 1 , Katharina Blattner 1 , Jill Muirhead 1 , Ngaire Kerse 21 Dunedin School of Medicine, University of Otago Dunedin, New Zealand
2 School of Population Health, University of Auckland, Tamaki, Auckland, New Zealand
Correspondence to: Gary Nixon, Dunedin School of Medicine, University of Otago Dunedin, New Zealand. Email: garry.nixon@otago.ac.nz
Journal of Primary Health Care 10(4) 324-330 https://doi.org/10.1071/HC18034
Published: 7 December 2018
Journal Compilation © Royal New Zealand College of General Practitioners 2018.
This is an open access article licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
Abstract
INTRODUCTION: Point-of-care ultrasound (POCUS) of the kidney and bladder are among the most commonly performed POCUS scans in rural New Zealand (NZ).
AIM: To determine the quality, safety and effect on patient care of POCUS of the kidney and bladder in rural NZ.
METHODS: Overall, 28 doctors in six NZ rural hospitals completed a questionnaire both before and after undertaking a POCUS scan over a 9-month period. The clinical records and saved ultrasound images were reviewed by a specialist panel.
RESULTS: The 28 participating doctors undertook 138 kidney and 60 bladder scans during the study. POCUS of the bladder as a test for urinary retention had a sensitivity of 100% (95% CI 88–100) and specificity of 100% (95% CI 93–100). POCUS of the kidney as a test for hydronephrosis had a sensitivity 90% (95% CI 74–96) and specificity of 96% (95% CI 89–98). The accuracy of other findings such as renal stones and bladder clot was lower. POCUS of the bladder appeared to have made a positive contribution to patient care in 92% of cases without evidence of harm. POCUS of the kidney benefited 93% of cases, although in three cases (2%), it may have had a negative effect on patient care.
DISCUSSION: POCUS as a test for urinary retention and hydronephrosis in the hands of rural doctors was technically straightforward, improved diagnostic certainty, increased discharges and overall had a positive effect on patient care.
KEYWORDS: POCUS; scans; hydronephrosis
References
[1] Nixon G, Blattner K, Lawrenson R, Kerse N. The scope of point-of-care ultrasound practice in rural New Zealand. J Prim Health Care. 2018; 10 224–36.| The scope of point-of-care ultrasound practice in rural New Zealand.Crossref | GoogleScholarGoogle Scholar |
[2] Dalziel PJ, Noble VE. Bedside ultrasound and the assessment of renal colic: a review. Emerg Med J. 2013; 30 3–8.
| Bedside ultrasound and the assessment of renal colic: a review.Crossref | GoogleScholarGoogle Scholar |
[3] Davis C, Chrisman J, Walden P. To scan or not to scan? Detecting urinary retention. Nursing Made Incredibly Easy. 2012; 10 53–4.
| To scan or not to scan? Detecting urinary retention.Crossref | GoogleScholarGoogle Scholar |
[4] Nixon G, Samaranayaka A, de Graaf B, McKechnie R, Blattner K, Dovey S. Geographic disparities in the utilisation of computed tomography scanning services in southern New Zealand. Health Policy. 2014; 118 222–8.
| Geographic disparities in the utilisation of computed tomography scanning services in southern New Zealand.Crossref | GoogleScholarGoogle Scholar |
[5] Council of Australasian College for Emergency Medicine. Policy on the focused use of focused ultrasound in emergency medicine. Melbourne: Australasian College for Emergency Medicine; 2016.
[6] American College of Emergency Physicians Ultrasound Guidelines: Emergency, Point-of-Care and clinical ultrasound guidelines in medicine. Ann Emerg Med. 2017; 69 e27–e54.
[7] Nixon G, Blatter K, Koroheke-Rogers M,, et al. Point-of-care ultrasound in rural New Zealand: safety, quality and impact on patient management. Aust J Rural Health. 2018; 26 342–9.
| Point-of-care ultrasound in rural New Zealand: safety, quality and impact on patient management.Crossref | GoogleScholarGoogle Scholar |
[8] MEDCALC®. 2018 Easy-to-use statistical software. Ostend: Belgium; 2018 [cited 2018 October 26]. Available from: https://www.medcalc.org/calc/diagnostic_test.php
[9] Weatherall M, Harwood M. The accuracy of clinical assessment of bladder volume. Arch Phys Med Rehabil. 2002; 83 1300–2.
| The accuracy of clinical assessment of bladder volume.Crossref | GoogleScholarGoogle Scholar |
[10] Hvarness H, Skjoldbye B, Jakobsen H. Urinary bladder volume measurements: comparison of three ultrasound calculation methods. Scand J Urol Nephrol. 2002; 36 177–81.
| Urinary bladder volume measurements: comparison of three ultrasound calculation methods.Crossref | GoogleScholarGoogle Scholar |
