title: Point of care ultrasound (POCUS) telemedicine project in rural Nicaragua and its impact on patient management.
abstract: BACKGROUND
  Point of care ultrasound (POCUS) is a useful diagnostic tool in medicine. POCUS provides an easy and reproducible method of diagnosis where conventional radiologic studies are unavailable. Telemedicine is also a great means of communication between educators and students throughout the world.
  
  
  OBJECTIVE
  Implementing POCUS with didactics and hands-on training, using portable ultrasound devices followed by telecommunication training, will impact the differential diagnosis and patient management in a rural community outside the United States.
  
  
  METHODS
  This is an observational prospective study implementing POCUS in Las Salinas, a small village in rural western Nicaragua. Ultrasound was used to confirm a diagnosis based on clinical exam, or uncover a new, previously unknown diagnosis. The primary endpoint was a change in patient management. International sonographic instructors conducted didactic and practical training of local practitioners in POCUS, subsequently followed by remote guidance and telecommunication for 3 months.
  
  
  RESULTS
  A total of 132 patients underwent ultrasound examination. The most common presentation was for a prenatal exam (23.5 %), followed by abdominal pain (17 %). Of the 132 patients, 69 (52 %) were found to have a new diagnosis. Excluding pregnancy, 67 patients of 101 (66 %) were found to have a new diagnosis. A change in management occurred in a total of 64 (48 %) patients, and 62 (61 %) after excluding pregnancy.
  
  
  CONCLUSIONS
  Implementing POCUS in rural Nicaragua led to a change in management in about half of the patients examined. With the appropriate training of clinicians, POCUS combined with telemedicine can positively impact patient care.
authors.affiliation: Department of Surgery/Division of Trauma and Critical Care, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202 USA.
authors.forename: Nina
authors.initials: N
authors.lastname: Kolbe
authors.affiliation: Department of Surgery/Division of Trauma and Critical Care, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202 USA ; Henry Ford Hospital, Ultrasound University, Detroit, MI USA.
authors.forename: Keith
authors.initials: K
authors.lastname: Killu
authors.affiliation: Department of Surgery/Division of Trauma and Critical Care, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202 USA ; Henry Ford Hospital, Ultrasound University, Detroit, MI USA.
authors.forename: Victor
authors.initials: V
authors.lastname: Coba
authors.affiliation: Henry Ford Hospital, Ultrasound University, Detroit, MI USA ; World Interactive Network Focused on Critical Ultrasound, A. O. Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Neri
authors.affiliation: Henry Ford Hospital, Ultrasound University, Detroit, MI USA ; Wyle Science, Technology and Engineering, El Segundo, CA USA.
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Garcia
authors.affiliation: Houston Methodist Hospital, Houston, TX USA.
authors.forename: Marti
authors.initials: M
authors.lastname: McCulloch
authors.affiliation: Department of Surgery/Division of Trauma and Critical Care, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202 USA ; Henry Ford Hospital, Ultrasound University, Detroit, MI USA ; World Interactive Network Focused on Critical Ultrasound, A. O. Niguarda Ca' Granda Hospital, Milan, Italy.
authors.forename: Alberta
authors.initials: A
authors.lastname: Spreafico
authors.affiliation: Department of Surgery/Division of Trauma and Critical Care, Henry Ford Hospital, 2799 W. Grand Blvd, Detroit, MI 48202 USA ; Henry Ford Hospital, Ultrasound University, Detroit, MI USA ; Wyle Science, Technology and Engineering, El Segundo, CA USA.
authors.forename: Scott
authors.initials: S
authors.lastname: Dulchavsky
keywords: Point of care ultrasound; Rural medicine; Telemedicine