Pocket ultrasound device as a complement to physical examination for ascites evaluation and guided paracentesis

Abstract

The pocket ultrasound device (PUD) is a new tool that may be of use in the early detection of ascites. Abdominal ultrasound-guided paracentesis has been reported to decrease the rate of complications due to the procedure, but must be performed in a healthcare setting; this new tool may be a useful on an ambulatory basis. The aim of this study was to determine the diagnostic usefulness of the PUD in the diagnosis of ascites and the safety of guided paracentesis. We conducted a retrospective study that included adult patients suspected of having ascites and in whom an evaluation was performed with the PUD to identify it. Concordance with abdominal ultrasound (AUS) was determined with the Kappa coefficient. Sensitivity (Se), specificity (Sp) and likelihood ratios (LR) were determined and compared with physical examination, AUS, computed tomography and procurement of fluid by paracentesis. Complications resulting from the guided paracentesis were analyzed. 89 participants were included and 40 underwent a paracentesis. The PUD for ascites detection had 95.8 % Se, 81.8 % Sp, 5.27 +LR and 0.05 -LR. It had a concordance with AUS of 0.781 (p < 0.001). Technical problems during the guided paracentesis were present in only two participants (5 %) and three patients (7.5 %) developed minor complications that required no further intervention. There were no severe complications or deaths. This study suggests that the PUD is a reliable tool for ascites detection as a complement to physical examination and appears to be a safe method to perform guided paracentesis.

The Use of Handheld Ultrasound Devices – An EFSUMB Position Paper

“…In 216 trauma patients, HHUSD FAST-scanning had an NPV of 99.5 %, signifying that HHUSDs could be used to rule out free abdominal fluid [12]. Concordantly, in patients clinically suspected of ascites, HHUSDs successfully confirmed the diagnosis in 96 % of cases, while the diagnosis was only missed in mild cases as assessed by conventional ultrasound or computed tomography (CT) [14]. In the same study HHUSD-guided paracentesis of ascites was feasible in 38 of 40 patients, with no severe complications.…”

Hand-Held Ultrasound Devices Compared with High-End Ultrasound Systems: A Systematic Review

“…Two articles not included in this review showed good overall agreement for detecting B-lines in patients with heart failure, as well as for visualising the diaphragm [37,38]. Some articles concerning hand-held ultrasound in abdominal pathology were not limited to comparing hand-held ultrasound devices with a specific high-end system [29,39,40,41], but were compared with other diagnostic measures, such as physical examination, CT and MRI, as well as US and were not included in this paper.…”

Evaluation of Trainee Competency with Point-of-Care Ultrasonography (POCUS): a Conceptual Framework and Review of Existing Assessments

“…Abdominal POCUS can be used to readily identify a variety of pathological states including ascites, cholecystitis, cholelithiasis, nephrolithiasis, hydronephrosis, and abdominal aortic aneurysm. [54][55][56] Its use has been shown to improve diagnostic accuracy and reduce ER length of stay. 55,56 While abdominal POCUS is incorporated into standardized examinations such as the Focused Assessment with Sonography for Trauma (FAST), these examinations are subject to variability based on user experience and have not been extensively validated as tools to assess competency.…”