Time Required to Perform Point-of-Care Ultrasound in an Academic Nephrology Hospital Service

Point-of-care ultrasound (POCUS) is a real-time exam performed and interpreted by a treating physician at the time of a clinical encounter to answer a focused clinical question. In nephrology, POCUS is most used to identify kidney pathology and assess volume status.1Ross D.W. Moses A.A. Niyyar V.D. Point-of-care ultrasonography in nephrology comes of age.Clin Kidney J. 2022; 15: 2220-2227https://doi.org/10.1093/ckj/sfac160Crossref PubMed Scopus (3) Google Scholar, 2Taleb Abdellah A. Koratala A. Nephrologist-performed point-of-care ultrasound in acute kidney injury: beyond hydronephrosis.Kidney Int Rep. 2022; 7: 1428-1432https://doi.org/10.1016/j.ekir.2022.02.017Abstract Full Text Full Text PDF Scopus (2) Google Scholar A recent survey by the nephrology fellowship training program directors and nephrology fellows revealed that only 38% of fellows received POCUS education during fellowship.3Moore C.A. Ross D.W. Pivert K.A. Lang V.J. Sozio S.M. O'Neill W.C.I. Point-of-care ultrasound training during nephrology fellowship: a national survey of fellows and program directors.Clin J Am Soc Nephrol. 2022; 17: 1487-1494https://doi.org/10.2215/CJN.01850222Crossref PubMed Scopus (10) Google Scholar POCUS has failed to gain traction in nephrology education and practice due to a lack of available educators, the expense of equipment, and a perceived lack of time. This study aims to quantify the time spent performing POCUS and assess diagnostic accuracy in the hands of a trained nephrologist in the inpatient setting (Supplementary Methods). During the 2-week period of the study, 24 POCUS studies were performed. Eight kidney, 20 lung, and 14 cardiac studies were performed as indicated. The average duration of the studies was 4.7 minutes (± 2.3). Of the cases, 28% (7/24) had a formal study pending at the time of the POCUS examination. Of these cases, 100% (7/7) of the POCUS exams correlated with the subsequent formal report (Table 1). Out of all 24 studies, POCUS results helped to guide management in 33% (8/24) of cases. The adjustments included diuretics (5/8), fluids (2/8), and midodrine/albumin (1/8).Table 1Nephrologist performed POCUS examinations compared to formal radiology studyAgePatient sexReason for consultTime POCUS doneTime and type of formal StudyPOCUS resultFormal study resultAgree with POCUS59MAKI9:07Kidney US at 9:33No hydronephrosisNo hydronephrosis; small volume ascitesYes52FAKI on CKD7:25Kidney US at 9:22Right kidney transplant; No hydronephrosisNo hydronephrosisYes39MAKI14:23CT Chest at 16:04clear on right but large effusion of leftLarge loculated left pleural effusionYes61FAKI12:29CT Chest at 11:01 (the following day)B-Line patternBilateral upper lung predominant peripheral reticular opacities; Small pleural effusion.Yes97FAKI on CKD8:53CT Chest at 16:31Bilateral B-line patternSmall bilateral pleural effusionsYes79FAKI on CKD8:46CXR at 13:51Scattered B lines with irregular pleuraInterstitial pulmonary edema; Persistent small bilateral pleural effusionsYes44MAKI on CKD6:57Renal US at 14:00No hydronephrosisIncreased renal echogenicity, suggesting medical renal disease. No hydronephrosisYesAKI, acute kidney injury; CKD, chronic kidney disease; CT, computed tomography; CXR, chest x-ray; F, Female; M, Male; POCUS, point-of-care ultrasound; US, ultrasound. Open table in a new tab AKI, acute kidney injury; CKD, chronic kidney disease; CT, computed tomography; CXR, chest x-ray; F, Female; M, Male; POCUS, point-of-care ultrasound; US, ultrasound. We have demonstrated that POCUS can answer basic clinical questions without significant additional time required during rounds. For assessing binary questions such as volume status or hydronephrosis, we found that POCUS examinations could broadly correlate with official radiographic studies in 7/7 (100%) of cases. A prospective observational study done in the emergency department revealed a sensitivity and specificity of approximately 70% for identifying hydronephrosis in patients presenting with renal colic.4Sibley S. Roth N. Scott C. et al.Point-of-care ultrasound for the detection of hydronephrosis in emergency department patients with suspected renal colic.Ultrasound J. 2020; 12: 31https://doi.org/10.1186/s13089-020-00178-3Crossref PubMed Scopus (18) Google Scholar Similarly, in the evaluation of acute dyspnea in the emergency department, POCUS showed a concordance of greater than 70% with radiographic studies.5Zanobetti M. Scorpiniti M. Gigli C. et al.Point-of-care ultrasonography for evaluation of acute dyspnea in the ED.Chest. 2017; 151: 1295-1301https://doi.org/10.1016/j.chest.2017.02.003Abstract Full Text Full Text PDF PubMed Scopus (197) Google Scholar Our reported time per study (4.6 minutes) was comparable to the length achieved by nephrologists (5 minutes).6Zoccali C. Torino C. Mallamaci F. et al.A randomized multicenter trial on a lung ultrasound-guided treatment strategy in patients on chronic hemodialysis with high cardiovascular risk.Kidney Int. 2021; 100: 1325-1333https://doi.org/10.1016/j.kint.2021.07.024Abstract Full Text Full Text PDF PubMed Scopus (45) Google Scholar Although the implementation of POCUS into nephrology training is feasible based on this study, further efforts must be made to eliminate barriers to training. All the authors declared no competing interests. Download .pdf (.14 MB) Help with pdf files Supplementary File (PDF)Supplementary Methods.