title: The use of a pocket-sized ultrasound device improves physical examination: results of an in- and outpatient cohort study.
abstract: BACKGROUND
  The performance of pocket mobile ultrasound devices (PUDs) is comparable with that of standard ultrasonography, whereas the accuracy of a physical examination is often poor requiring further tests to assess diagnostic hypotheses. Adding the use of PUD to physical examination could lead to an incremental benefit.
  
  
  OBJECTIVE
  We assessed whether the use of PUD in the context of physical examination can reduce the prescription of additional tests when used by physicians in different clinical settings.
  
  
  METHODS
  We conducted a cohort impact study in four hospital medical wards, one gastroenterological outpatient clinic, and 90 general practices in the same geographical area. The study involved 135 physicians who used PUD, after a short predefined training course, to examine 1962 consecutive patients with one of 10 diagnostic hypotheses: ascites, pleural effusion, pericardial effusion, urinary retention, urinary stones, gallstones, biliary-duct dilation, splenomegaly, abdominal mass, abdominal aortic aneurysm. According to the physicians' judgment, PUD examination could rule out or in the diagnostic hypothesis or require further testing; the concordance with the final diagnosis was assessed. The main outcome was the proportion of cases in which additional tests were required after PUD. The PUD diagnostic accuracy was assessed in patients submitted to further testing.
  
  
  RESULTS
  The 1962 patients included 37% in-patients, 26% gastroenterology outpatients, 37% from general practices. Further testing after PUD examination was deemed unnecessary in 63%. Only 5% of patients with negative PUD not referred for further testing were classified false negatives with respect to the final diagnosis. In patients undergoing further tests, the sensitivity was 91%, and the specificity 83%.
  
  
  CONCLUSIONS
  After a simple and short training course, a PUD examination can be used in addition to a physical examination to improve the answer to ten common clinical questions concerning in- and outpatients, and can reduce the need for further testing.
authors: Internal Medicine Department, Ospedale A Manzoni, Lecco, Italy.
authors: Agostino
authors: A
authors: Colli
authors: Department of Transfusion Medicine and Hematology, Ospedale A Manzoni, Lecco, Italy.
authors: Daniele
authors: D
authors: Prati
authors: Second Division of Gastroenterology, IRCCS Fondazione Ca Granda Ospedale Maggiore Policlinico, Università degli Studi di Milano, Milan, Italy.
authors: Mirella
authors: M
authors: Fraquelli
authors: Gastroenterology and GI Endoscopy Unit, Azienda Ospedaliero Universitaria Macchi, Varese, Italy.
authors: Sergio
authors: S
authors: Segato
authors: Division of Internal Medicine, Azienda Ospedaliera "Carlo Poma", Mantova, Italy.
authors: Pier Paolo
authors: PP
authors: Vescovi
authors: First Division of Internal Medicine, A.O. Niguarda, Milan, Italy.
authors: Fabrizio
authors: F
authors: Colombo
authors: Third Division of Internal Medicine, Fondazione IRCCS Policlinico San Matteo-Università degli Studi, Pavia, Italy.
authors: Carlo
authors: C
authors: Balduini
authors: Internal Medicine Department, Ospedale A Manzoni, Lecco, Italy.
authors: Serena
authors: S
authors: Della Valle
authors: Department of Biomedical and Clinical Sciences "L. Sacco," Università degli Studi di Milano, Milan, Italy.
authors: Giovanni
authors: G
authors: Casazza
mesh_terms: D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D010045:Outpatients; D010808:Physical Examination / Q000295:instrumentation*; D012015:Reference Standards; D011795:Surveys and Questionnaires; D014465:Ultrasonics / Q000295:instrumentation*