Evaluation Of Handheld Point-of-Care-Ultrasound (POCUS) in Screening for Abdominal Aortic Aneurysm in Men: A Comparative, Cohort Study

OBJECTIVE: Screening for abdominal aortic aneurysm (AAA) using ultrasound in men reduces aneurysm-related mortality. Ambulatory screening and surveillance procedures facilitated by point-of-care ultrasound (POCUS) may improve adherence to screening programs. This proof-of-concept study evaluated whether infrarenal aortic diameter (IAD) can be accurately and interchangeably measured using handheld POCUS-an ultrasound probe connected to a tablet-compared to standard cart-based ultrasound equipment. METHODS: This comparative cohort study included men with an IAD of 25-29 mm during AAA screening and re-examined them after 5-12 years, anticipating most would approach the 30 mm AAA threshold. Three IAD measurements were taken using both POCUS (Lumify™, Philips) and standard US (LOGIQ™ 9E, GE). Bias, limits of agreement between devices and repeatability within devices were evaluated. Sensitivity and specificity of POCUS for AAA detection (IAD ≥30 mm) compared to standard ultrasound were also assessed. RESULTS: In total, 230 men participated. The median age was 75.0 years (IQR: 72.9-76.5), BMI 27.7 (26.0-30.5), and IAD 27.1 mm (23.7-32.8) respectively. POCUS underestimated IAD by 0.3 mm compared to standard US, with 95% limits of agreement ±3.0 mm. Repeatability was ±2.5 mm for standard ultrasound and ±3.2 mm for POCUS. The sensitivity and specificity of POCUS for AAA diagnosis, compared to standard ultrasound, are 94% and 98%, respectively. CONCLUSION: POCUS showed no systematic bias of clinical importance in measuring IAD although with a slightly wider repeatability interval compared to standard US implying the possibility to consider POCUS devices for AAA-screening purposes.