Potential for Use of Portable Ultrasound Devices in Rural and Remote Settings in Australia and Other Developed Countries: A Systematic Review

Abstract

Introduction Point of care ultrasound (POCUS) has become more common for rapid evaluation. Applications are limited by lack of training of users, difficulty maintaining ultrasound competencies, access to equipment for optimal imaging, and limitations in quality control. Such barriers exist in low-resource, underserved health care settings. Objective The aim was to explore the use of POCUS in under-resourced health care settings, such as rural and remote locations in Australia and other countries. Key variables include health outcomes, quality of care, service availability, examinations types performed, equipment used, who performs the examinations, and the ultrasound training received. Methods Literature was identified via CINAHL, Cochrane, Embase, Medline, PubMed, SCOPUS, and Web of Science, plus grey literature. Recommended guidelines were followed, and only research-based articles were included, with searches limited to English language and 2010–present. Results After screening, 23 articles were reviewed. No studies had low risk of bias and, overall, the quality was poor and only two studies used random sampling. The majority were from developing countries, with only one performed in Australia. Echocardiographic screening in schools was common. Others included emergency department (ED) patients, abdominal aorta screening, obstetric scans, and intensive care unit (ICU) management. Operators included ED doctors, medical students, nurses, community healthcare workers and general practitioners, who received limited training in protocol-driven scanning, often monitored by experts. In comparison to clinical assessment, standard ultrasound or other imaging, accuracy was of the order of 70–95%, depending on the condition, with high efficacy in improving patient care. Conclusion Lack of studies of POCUS in Australia and other developed countries suggests a need for further research. Current evidence supports use of limited ultrasound using portable machines in locations with limited access to diagnostic ultrasound performed by sonographers, which has the potential to improve health outcomes in under-resourced communities in Australia and elsewhere.

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“… 25 Notably, portable ultrasounds have huge potential for use in low-resource underserved healthcare settings. 26 However, the lack of trained healthcare workers to operate these devices and the difficulty in maintaining competencies in resource-constrained areas need to be addressed to bridge the gap in ultrasound diagnostics. Additionally, its widespread adoption is hampered by the limited distribution and support networks, lack of access to replacement parts, and intermittent electric supply to recharge batteries.…”

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“… 1 , 2 , 3 , 4 It is evident that a diverse range of healthcare professionals are increasingly incorporating POCUS into patient screening practices. 5 , 6 , 7 , 8 However, some radiologists remain skeptical about its benefits for patients. 6 , 7 , 9 Therefore, it would be useful to assess the accuracy of POCUS findings made in a prehospital context, where there are no radiologists available.…”