title: Point-of-Care Ultrasound Use, Accuracy, and Impact on Clinical Decision Making in Rwanda Hospitals.
abstract: OBJECTIVE
  Few studies of point-of-care ultrasound training and use in low resource settings have reported the impact of examinations on clinical management or the longer-term quality of trainee-performed studies. We characterized the long-term effect of a point-of-care ultrasound program on clinical decision making, and evaluated the quality of clinician-performed ultrasound studies.
  
  
  METHODS
  We conducted point-of-care ultrasound training for physicians from Rwandan hospitals. Physicians then used point-of-care ultrasound and recorded their findings, interpretation, and effects on patient management. Data were collected for 6 months. Trainee studies were reviewed for image quality and accuracy.
  
  
  RESULTS
  Fifteen participants documented 1158 ultrasounds; 590 studies (50.9%) had matched images and interpretations for review. Abdominal ultrasound for free fluid was the most frequently performed application. The mean image quality score was 2.36 (95% confidence interval, 2.28-2.44). Overall sensitivity and specificity for trainee-performed examinations was 94 and 98%. Point-of-care ultrasound use most commonly changed medications administered (42.4%) and disposition (30%).
  
  
  CONCLUSIONS
  A point-of-care ultrasound training intervention in a low-resource setting resulted in high numbers of diagnostic-quality studies over long-term follow-up. Ultrasound use routinely changed clinical decision making.
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Patricia C
authors.initials: PC
authors.lastname: Henwood
authors.affiliation: Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA.
authors.forename: David C
authors.initials: DC
authors.lastname: Mackenzie
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Liteplo
authors.affiliation: Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Joshua S
authors.initials: JS
authors.lastname: Rempell
authors.affiliation: Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA.
authors.forename: Alice F
authors.initials: AF
authors.lastname: Murray
authors.affiliation: Department of Emergency Medicine, Boston Medical Center, Boston, Massachusetts, USA.
authors.forename: Megan M
authors.initials: MM
authors.lastname: Leo
authors.affiliation: University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda.
authors.forename: Damas
authors.initials: D
authors.lastname: Dukundane
authors.affiliation: Department of Emergency Medicine, Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania, USA.
authors.forename: Anthony J
authors.initials: AJ
authors.lastname: Dean
authors.affiliation: University Teaching Hospital of Kigali (CHUK), Kigali, Rwanda.
authors.forename: Stephen
authors.initials: S
authors.lastname: Rulisa
authors.affiliation: Department of Emergency Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA.
authors.forename: Vicki E
authors.initials: VE
authors.lastname: Noble
mesh_terms: D000328:Adult; D002983:Clinical Competence / Q000706:statistics & numerical data*; D000066491:Clinical Decision-Making / Q000379:methods*; D015331:Cohort Studies; D004521:Educational Measurement / Q000706:statistics & numerical data*; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems / Q000706:statistics & numerical data*; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D015203:Reproducibility of Results; D012432:Rwanda / Q000453:epidemiology; D012680:Sensitivity and Specificity; D014600:Utilization Review
keywords: education; global health; point of care; ultrasound