Validation of Family Medicine Point-of-Care Ultrasound Screening (POCUS) for Abdominal Aortic Aneurysm

Objective: Ruptured abdominal aortic aneurysms (AAA) carry a mortality rate as high as 80% . Early detection through a screening ultrasound can lead to a large mortality reduction. Point-of-care ultrasound (POCUS) has preliminary data suggesting it is as accurate as hospital-based ultrasounds performed by a sonographer. This validation study investigated the relative concordance of family physicians using POCUS to determine aortic diameter compared with hospital-based ultrasound studies. Methods: The study was a cross-sectional, multi-observation study conducted at 3 office practices. Five family physicians with varying degrees of training and experience utilized various ultrasound machines to measure maximal aortic diameter at the proximal, mid, and distal aorta. Hospital-based ultrasound or Computed Tomography (CT) served as the validation scan. Pairwise comparisons were made, with statistical testing for difference using the T-TEST command with the PAIRS subcommand. Results: Forty-four independent observations were completed by the 5 physicians on the 18 patients (n = 18). The mean difference between the POCUS and validation scans was 0.2 cm (95% CI −1.10 to 0.40). The family physicians generally underestimated the aortic diameter. The proximal aorta had the largest mean difference in aortic size (0.23 cm; P = .003). Type of ultrasound device used, the width of the largest aortic segment, and low patient body mass index had significant relations. Conclusion: This small study found data suggesting that family physicians with variable POCUS experience can accurately perform AAA screening in the ambulatory setting with either handheld or cart-based POCUS machines.