Table 2 Summary of Studies on Ultrasound’s Impact on Patient Care Management

Bussmann H, Koen E, Arhin-Tenkorang D, Munyadzwe G and Troeger J, 2001 [4]

Botswana

18 months

Real-time ultrasound scanner Siemens SL-1, with a 3.5 MHz/5 MHz sector probe and a 5 – MHz linear probe.

Quantitative study - no control group included. Clinical diagnosis compared with ultrasound-aided diagnosis without blinding.

Clinicians made a provisional clinical diagnosis. Then, the sonographer made an ultrasound-aided diagnosis with knowledge of the clinical diagnosis.

Patients were enrolled based on a pre-developed indication list. The list included conditions relevant to the study hospital where ultrasound diagnosis could be useful: obstetric, cystic and solid masses differentiation, urinary or biliary obstruction, detection of fluid in peritoneal, pleural or pericardial cavity or ventricular brain space, etc.

Diagnosis by ultrasound was categorized as either “similar improved”, “different improved” or “not improved”. “Similar improved” indicated ultrasound providing a diagnosis of high certainty when clinical diagnosis was of low certainty. “Different improved” indicated ultrasound providing a diagnosis of high certainty when clinical diagnosis had not been ascertained. “Not improved” indicated ultrasound diagnosis being of equal certainty with clinical diagnosis or if no pathology was found.

Overall, 334 of 722 (45%) of all pregnant cases had improved diagnosis due to ultrasound examination.

Of the 334 improved cases, 201 (27%) were categorized as “similar improved” and 133 (18%) were categorized as “different improved”.

For 49 cases, care management changed immediately after the ultrasound diagnosis.

This study showed that ultrasound examinations can aid clinical diagnosis and thereby contribute to improving the quality of care in a district hospital.

2309 patients

Life Sciences and Technology for Developing Countries program of the Commission of the European Communities supported the study.

Kimberly HH, Murray A, Mennicke M, Liteplo A, Lew J, Bohan JS, et al. 2010 [6]

Zambia

6 months

SonoSite 180 portable ultrasound, with an extra battery, a curved array abdominal probe and software for image storing

Quantitative study - no control group included. Observed examinations conducted at midterm and at the end. “Most recorded scans were performed in second and third trimester.”

21 midwives underwent three training periods which were 2 to 3 weeks in length and were separated by 2 to 3 months of independent scanning. Training took place in the form of didactic sessions, practical hands on sessions and supervised scanning.

The training content included identification of fetal presentation, fetal heart rate, placental location, multiple gestations, and estimation of gestational age based on biparietal diameter and femur length.

From a total of 441 ultrasound scans that were performed, 74 ultrasound scans (17%) led to a change in clinical decision-making.

Of the cases that had a change in clinical management, non-vertex presentation, multiple gestations, lack of fetal heart rate and low lying placenta consisted over 95% of the findings.

441 scans performed

SonoSite donated ultrasound machines

Kotlyar S and Moore CL, 2008 [11]

Liberia

5 weeks

A portable LOGIQe US unit, with a 2.5-MHz curvilinear probe, a 5-MHz phased array cardiac probe, a 7-MHz linear probe, and a 4.5-MHz endovaginal probe. Doppler and color flow capabilities were available.

Quantitative study - no control group included. Pre-ultrasound diagnosis compared with After-ultrasound diagnosis.

“Ultrasound images were acquired by residency trained emergency physicians as part of routine patient care. Upon physicians’ requests, ultrasound was performed on inpatients in the medical, pediatric, surgical and obstetrical wards as well as patients in the emergency room.”

Ultrasound examination changed patient management in 62% of cases.

Of the cases that had a change in patient management, the highest impact was seen with first trimester obstetric conditions, focused assessment of sonography in trauma exam, cardiac applications and second and third trimester obstetric conditions.

102 patients

GE Medical loaned ultrasound equipment

Stein W, Katunda I and Butoto C, 2008 [27]

Tanzania

12 months

Siemens SL-1, with a 3.5 MHz/5 MHz sector probe, 8 MHz vaginal probe.

Quantitative study - no control group included. Clinical diagnosis compared with ultrasound-aided diagnosis.

The first-level ultrasound was randomly conducted on patients with absent fetal heartbeat and suspect fetal position other than cephalic. For suspected twins and vaginal bleeding, it was regularly re-examined. The second-level advanced ultrasound was performed by a specialist sonographer for patients with fundal height discrepancies, suspected incomplete abortion, suspected extra uterine pregnancy and abdominal pain.

Midwives received two months of training in basic obstetric ultrasound to perform first-level ultrasound services.

During the study period, 542 patients were enrolled. Of which, ultrasound diagnosis improved clinical management in 212 (39.1%) of the cases, conflicted with original clinical diagnosis in 81 cases (14.9%) and led to a change of management in 121 cases (22.3%).

542 patients

Not Mentioned

Shah SP, Epino H, Bukhman G, Umulisa I, Dushimiyimana JM, Reichman A, et al. 2009 [14]

Rwanda

19 weeks +

Sonosite Micromaxx, with endocavitary probe, a curved array abdominal probe and cardiac probes

Quantitative study - no control group included. Blinded review of ultrasound scans for accuracy and quality.

Datasheets for each ultrasound scan performed during routine clinical care were collected and analyzed.

Local physician staff underwent a 9-week ultrasound training curriculum that included lectures and practical hands-on sessions.

Lecture topics included obstetrical ultrasound, cardiac ultrasound, hepato-biliary ultrasound and other advanced uses of ultrasound.

Providers at the study sites indicated that ultrasound scans changed their initial patient management plan in 43% of the cases.

The most commonly reported change after the ultrasound was the consideration to perform a surgical procedure such as a cesarean section, biopsy or minor surgery. Cesarean sections were decided if the patient had breech presentation, placenta previa or multiple gestations.

345 ultrasound scans

SonoSite donated ultrasound machines

Wylie BJ, Kalilani-Phiri L, Madanitsa M, Membe G, Nyirenda O, Mawindo P, et al. 2013 [8]

Malawi

4 months +

SonoSite 180 portable ultrasound

Quantitative study - no control group included. Comparison of ultrasound-aided dating and menstrual gestational age/postnatal Ballard estimation.

“61.8% of the subjects were enrolled and imaged between 20 and 27 weeks. 21.3% were imaged after 28 weeks. 16.3% were imaged prior to 20 weeks.”

8 trainees (four research staff, one nurse, three midlevel clinicians) received an intensive one-week ultrasound training for fetal biometry. Four months of additional practice and remote image review followed.

Ultrasound scans were used to confirm menstrual gestational age in 62.1% of the cases.

13% were not aware of their last menstrual dates and thus had their gestational age calculated solely by ultrasound.

24.9% of the cases had to have their gestational age re-dated by ultrasound.

For over a third of the patients, ultrasound scans played a critical role in improving the accuracy of their gestational age.

Because Malaria during pregnancy is a risk factor for low birth weight, accurate dating by ultrasound can facilitate appropriate clinical management

178 patients

Ultrasound machines donated by Vincent Department of Obstetrics and Gynecology at the Massachusetts General Hospital with a matching grant from the SoundCaring Program (Sonosite). Research supported by the Doris Duke Charitable Foundation and by the National Institute of Health.

Spencer JK and Adler RS, 2008 [28]

Ghana

1 month

A LOGIQ Book portable ultrasound, with a linear L5–10 MHz and curvilinear C3–5 MHz broadband transducers.

Quantitative study - no control group included. Determination of whether ultrasound aided clinical diagnosis.

Patients were seen by a radiologist trained in general abdominal ultrasound, obstetric ultrasound, small parts and musculoskeletal ultrasound, and other procedures by ultrasound in a variety of clinical settings: a surgeon’s office, hospital operating room and clinics. Diagnoses included both infectious and non-infectious diseases.

Of the total 67 ultrasound scans performed, 54 (81%) of them were considered to be abnormal findings.

All of the abnormal findings enhanced clinical diagnosis and 40% either influenced the outcome or the clinical decision-making regarding treatment.

67 patients

GE Healthcare provided a LOGIQ Book portable ultrasound

Steinmetz JP and Berger JP, 1999 [12]

Cameroon

16 months

Multipurpose ALOKA 256, with two linear probes of 3.5 and 5 MHz

Quantitative study - no control group included.

Comparison between those in which the diagnosis by ultrasonography was confirmed by a certified diagnosis and those in which the diagnosis by ultrasonography could not be confirmed.

Ultrasound exams were requested by a nurse or a doctor and performed by one surgeon-echographist.

Indications for ultrasound exams included gynecology, liver, spleen and biliary tract, gastrointestinal tract, pregnancy, renal-urinary tract and others.

In the retrospective review of 1119 ultrasound scans, 78% of the scans were deemed as abnormal findings.

67.8% were judged useful in clinical diagnosis and management and only 4.6% were judged to be erroneous.

In addition, for nearly a half of the cases that had been confirmed by tissue pathology, additional imaging tests, endoscopy, surgical specimen or laboratory diagnosis, ultrasound scans suggested a differential diagnosis which had not been previously considered.

1119 ultrasound scans

Samaritan Hospital provided the ultrasound machine.

Foundation de Jumelage Oona Chaplin provided funding support.

Shorter M and Macias DJ, 2012 [16]

Haiti

12 days

Signos handheld ultrasound, with a 3.5 MHz and a 7.0 MHz removable probe.

Quantitative study - no control group included. Retrospective, non-blinded, observational analysis of ultrasound scans.

Ultrasound was performed by one registered diagnostic medical sonographer-eligible emergency physician sonographer (with only 8 h of prior experience with the handheld device)

“Ultrasound was performed for complaints or symptoms indicative of illnesses that could potentially be triaged or diagnosed by ultrasound (internal bleeding, pregnancy, shock and cardiac dysfunction).”

The use of portable hand-held ultrasound devices led to a change in 70% of patient management plans.

Portable ultrasound imaging was found especially useful for non-traumatic abdominal pain and pregnancy-related symptoms.

50 patients

Not Mentioned