title: The use of portable ultrasound devices in low- and middle-income countries: a systematic review of the literature.
abstract: OBJECTIVE
  To review the scientific literature pertaining to the use of hand-carried and hand-held ultrasound devices in low- and middle-income countries (LMIC), with a focus on clinical applications, geographical areas of use, the impact on patient management and technical features of the devices used.
  
  
  METHODS
  The electronic databases PubMed and Google Scholar were searched. No language or date restrictions were applied. Case reports and original research describing the use of hand-carried ultrasound devices in LMIC were included if agreed upon as relevant by two-reviewer consensus based on our predefined research questions.
  
  
  RESULTS
  A total of 644 articles were found and screened, and 36 manuscripts were included for final review. Twenty-seven studies were original research articles, and nine were case reports. Several reports describe the successful diagnosis and management of difficult, often life-threatening conditions, using hand-carried and hand-held ultrasound. These portable ultrasound devices have also been studied for cardiac screening exams, as well as a rapid triage tool in rural areas and after natural disaster. Most applications focus on obstetrical and abdominal complaints. Portable ultrasound may have an impact on clinical management in up to 70% of all cases. However, no randomised controlled trials have evaluated the impact of ultrasound-guided diagnosis and treatment in resource-constrained settings. The exclusion of articles published in journals not listed in the large databases may have biased our results. Our findings are limited by the lack of higher quality evidence (e.g. controlled trials).
  
  
  CONCLUSIONS
  Hand-carried and hand-held ultrasound is successfully being used to triage, diagnose and treat patients with a variety of complaints in LMIC. However, the quality of the current evidence is low. There is an urgent need to perform larger clinical trials assessing the impact of hand-carried ultrasound in LMIC.
authors.affiliation: Department of Internal Medicine, St. Joseph Mercy Hospital Ann Arbor - St. Joseph Mercy Health System, Ann Arbor, MI, USA.
authors.forename: Dawn M
authors.initials: DM
authors.lastname: Becker
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Chelsea A
authors.initials: CA
authors.lastname: Tafoya
authors.affiliation: Department of Epidemiology and Public Health, Swiss Tropical and Public Health Institute, Basel, Switzerland.|University of Basel, Basel, Switzerland.|Institute of Medical Microbiology and Hygiene, Saarland University Medical Center, Homburg/Saar, Germany.
authors.forename: Sören L
authors.initials: SL
authors.lastname: Becker
authors.affiliation: Department of Mechanical Engineering, College of Engineering, University of Michigan, Ann Arbor, MI, USA.
authors.forename: Grant H
authors.initials: GH
authors.lastname: Kruger
authors.affiliation: University of Michigan Medical School, Ann Arbor, MI, USA.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Tafoya
authors.affiliation: Department of Critical Care Medicine, University of Pittsburgh Medical Center, Pittsburgh, PA, USA.
authors.forename: Torben K
authors.initials: TK
authors.lastname: Becker
mesh_terms: D003906:Developing Countries / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000706:statistics & numerical data; D006801:Humans; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D014463:Ultrasonography / Q000706:statistics & numerical data*; D016216:Ultrasonography, Prenatal / Q000706:statistics & numerical data
keywords: Ultrasonido; clinical examination; diagnosis; recursos; resource-constrained settings; ressource; ultrasound; échographie