title: Change in differential diagnosis and patient management with the use of portable ultrasound in a remote setting.
abstract: OBJECTIVE
  Physicians practicing in remote areas are typically limited in their choice of diagnostic tools. The goal of this study was to determine whether the use of a portable ultrasound (US) device on selected patients in a remote setting would alter physician diagnosis and management.
  
  
  METHODS
  This was a prospective observational study of the affects of US on physician decision making deep in the Amazon jungle. A battery-operated Sonosite 180 Plus with 2 interchangeable transducers (4-7-MHz broadband intercavitary transducer and 2-5-MHz broadband abdominal transducer) was used. The patient population consisted of local tribal people. Two of the physicians on the team performed all US examinations. Team physicians requesting US examinations filled out a survey before and after the US examination. Before the US, the referring physician filled out a survey describing the patient's initial complaint, pertinent past medical history and physical findings, and an initial (pre-US) differential diagnosis and planned treatment with expected disposition. After the results of the US were reviewed with the referring physicians, the doctors were asked to fill out the remainder of the survey, allowing comparison of pre- and post-US differential diagnosis, treatment plan, and disposition.
  
  
  RESULTS
  A total of 25 US studies were performed during this study (1 trauma US scan, 6 hepatobiliary studies, 5 transabdominal pelvic scans, 7 transvaginal pelvic studies, 3 renal studies, and 3 abdominal aortic scans). The monitor on the US unit experienced a rare failure shortly after being used at 17,000 ft and then 10 times at sea level, and no further US scans could be performed. US scan results dramatically altered the disposition of 7 patients, including 4 patients who avoided a potentially dangerous 2-day evacuation to more definitive medical care. Three patients were found to need rapid referral to the nearest clinic for surgical evaluation.
  
  
  CONCLUSIONS
  When used in a remote location, portable US provides a significant benefit that can dramatically alter disposition and treatment.
authors.affiliation: Department of Emergency Medicine, Medical College of Georgia, Augusta, GA 30912-4007, USA. blaivas@pyro.net
authors.forename: Michael
authors.initials: M
authors.lastname: Blaivas
authors.forename: Walter
authors.initials: W
authors.lastname: Kuhn
authors.forename: Brad
authors.initials: B
authors.lastname: Reynolds
authors.forename: Larry
authors.initials: L
authors.lastname: Brannam
mesh_terms: D001938:Brazil; D003937:Diagnosis, Differential; D004630:Emergencies; D004638:Emergency Treatment; D004867:Equipment Design; D006801:Humans; D019095:Point-of-Care Systems / Q000706:statistics & numerical data; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D014463:Ultrasonography / Q000706:statistics & numerical data*