title: Do pocket-sized ultrasound machines have the potential to be used as a tool to triage patients in obstetrics and gynecology?
abstract: OBJECTIVE
  To evaluate the performance and potential impact on patient management of a pocket-sized ultrasound machine (PUM) in comparison to high-specification ultrasound machines (HSUM).
  
  
  METHODS
  This was an observational cohort study with 204 unselected patients in three categories: 1) women with pain and bleeding in early pregnancy (101 patients); 2) women presenting for routine obstetric ultrasound assessment (53 patients); 3) women with possible gynecological pathology (50 patients). Scans were carried out transabdominally using a PUM. A second operator repeated the examination transvaginally and/or transabdominally, depending on the clinical indication, using an HSUM. The operators were blind to each other's findings.
  
  
  RESULTS
  In the early pregnancy group, there was good to very good agreement between the PUM and HSUM for identifying the presence or absence of an embryo, gestational sac, fetal heart motion, pregnancy location and final diagnostic outcome (kappa coefficients, 0.844, 0.843, 0.729, 0.785 and 0.812, respectively; P < 0.0001). In the obstetric ultrasound group there was good to very good agreement for fetal presentation, placental location and placental position (kappa coefficients, 0.924, 0.924 and 0.647, respectively; P < 0.0001). In the gynecological pathology group, there was very good agreement for final diagnosis and type of ovarian mass (low risk or complex) (kappa coefficients, 0.846 and 0.930, respectively; P < 0.0001). For the measured continuous variables, there was close agreement for crown-rump length, mean sac diameter, femur length and mean diameter of an ovarian mass, but not for endometrial thickness. Neither patient demographics (age, body mass index, ethnicity) nor operator experience and familiarity with a PUM had an impact on agreement between the two machines. If a PUM had been the only equipment available for an initial assessment, only two cases would have led to a suboptimal patient management plan.
  
  
  CONCLUSIONS
  The findings and final diagnosis in the three study groups were similar for both a PUM used transabdominally and an HSUM used transvaginally and/or transabdominally.
authors.affiliation: Early Pregnancy and Gynaecological Scanning Unit, Queen Charlotte's and Chelsea Hospital, Imperial College, London, UK. a.sayasneh@imperial.ac.uk
authors.forename: A
authors.initials: A
authors.lastname: Sayasneh
authors.forename: J
authors.initials: J
authors.lastname: Preisler
authors.forename: A
authors.initials: A
authors.lastname: Smith
authors.forename: S
authors.initials: S
authors.lastname: Saso
authors.forename: O
authors.initials: O
authors.lastname: Naji
authors.forename: Y
authors.initials: Y
authors.lastname: Abdallah
authors.forename: C
authors.initials: C
authors.lastname: Stalder
authors.forename: A
authors.initials: A
authors.lastname: Daemen
authors.forename: D
authors.initials: D
authors.lastname: Timmerman
authors.forename: T
authors.initials: T
authors.lastname: Bourne
mesh_terms: D000293:Adolescent; D000328:Adult; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008131:London; D011247:Pregnancy; D011446:Prospective Studies; D014218:Triage / Q000379:methods*; D016216:Ultrasonography, Prenatal / Q000295:instrumentation*; D055815:Young Adult