Rural point-of-care ultrasound of the kidney and bladder: Quality and effect on patient management

Abstract

INTRODUCTION: Point-of-care ultrasound (POCUS) of the kidney and bladder are among the most commonly performed POCUS scans in rural New Zealand (NZ). AIM: To determine the quality, safety and effect on patient care of POCUS of the kidney and bladder in rural NZ. METHODS: Overall, 28 doctors in six NZ rural hospitals completed a questionnaire both before and after undertaking a POCUS scan over a 9-month period. The clinical records and saved ultrasound images were reviewed by a specialist panel. RESULTS: The 28 participating doctors undertook 138 kidney and 60 bladder scans during the study. POCUS of the bladder as a test for urinary retention had a sensitivity of 100% (95% CI 88-100) and specificity of 100% (95% CI 93-100). POCUS of the kidney as a test for hydronephrosis had a sensitivity 90% (95% CI 74-96) and specificity of 96% (95% CI 89-98). The accuracy of other findings such as renal stones and bladder clot was lower. POCUS of the bladder appeared to have made a positive contribution to patient care in 92% of cases without evidence of harm. POCUS of the kidney benefited 93% of cases, although in three cases (2%), it may have had a negative effect on patient care. DISCUSSION: POCUS as a test for urinary retention and hydronephrosis in the hands of rural doctors was technically straightforward, improved diagnostic certainty, increased discharges and overall had a positive effect on patient care.