Authors' objectives: HTW undertook an evidence review to address the following question: Compared to other diagnostic techniques, what is the effectiveness of using handheld or portable ultrasound to aid diagnosis in people with suspected gallstones?

Authors' results and conclusions: Six studies were identified that evaluated the diagnostic accuracy of portable point-of-care ultrasound (POCUS). These studies varied in design including the use of different portable POCUS devices, different POCUS operators as well as the training given, and different reference standards (e.g. radiology ultrasound, final diagnosis at discharge). Across these six studies, diagnostic sensitivity ranged from 75% to 100% and specificity ranged from 84.4% to 100% for portable POCUS. Two of the six studies included a comparator. The first compared portable ‘laptop-sized’ POCUS against formal ultrasound, with final diagnosis as the reference standard; specificity was similar for both ultrasound methods, but sensitivity was higher with formal ultrasound. The second study compared handheld POCUS carried out by non-expert operators with handheld POCUS carried out by expert operators, with formal ultrasound as the reference standard. Sensitivity and specificity were both higher when handheld POCUS was performed by expert operators. An economic analysis developed by HTW showed handheld/portable POCUS to be cheaper but less effective than radiologist-performed ultrasound. However, the result was not robust across all scenario analyses.

Authors' recommendations: The use of portable point-of-care ultrasound (POCUS) to diagnose gallstone disease shows promise, but the current evidence is insufficient to support routine adoption. Studies to date have primarily considered the diagnostic accuracy of POCUS but uncertainties remain about the effectiveness of POCUS when used alongside other investigations as part of clinical decision-making. Due to uncertainties around clinical effectiveness, in particular the waiting time before receiving a scan, reliable conclusions about the potential economic consequences of using POCUS cannot be drawn. Further research is recommended to demonstrate the clinical and cost effectiveness of portable POCUS in emergency and acute care settings.

Authors' methods: The Evidence Appraisal Report is based on a literature search (strategy available on request) for published clinical and economic evidence on the health technology of interest. It is not a full systematic review but aims to identify the best available evidence on the health technology of interest. Researchers critically evaluate and synthesise this evidence. We include the following clinical evidence in order of priority: systematic reviews; randomised trials; non-randomised trials. We only include evidence for “lower priority” evidence where outcomes are not reported by a “higher priority” source. We also search for economic evaluations or original research that can form the basis of an assessment of costs/cost comparison. We carry out various levels of economic evaluation, according to the evidence that is available to inform this.

Authors' identified further research: HTW's Appraisal Panel considered that further research is merited on this technology and that this research should focus on: the use of portable POCUS in the investigation of patients with acute abdominal symptoms in an acute and emergency secondary care setting such as Emergency Departments and medical and surgical admissions units; the comparative diagnostic accuracy of portable POCUS imaging compared to standard care, as well as its impact on subsequent patient management, including the discovery of incidental diagnoses such as malignancy; and the complementary use of portable POCUS alongside current management strategies.

Project Status: Completed

URL for project: https://healthtechnology.wales/reports-guidance/point-of-care-gastroenterological-ultrasound/

Year Published: 2021

URL for published report: https://healthtechnology.wales/wp-content/uploads/2020/12/EAR029-POCUS-GS.pdf

English language abstract: An English language summary is available

Publication Type: Rapid Review

Country: Wales, United Kingdom

Organisation Name: Health Technology Wales

Contact Address: c/o Digital Health Care Wales, 21 Cowbridge Road East Cardiff CF11 9AD

Contact Name: Susan Myles, PhD

Contact Email: healthtechnology@wales.nhs.uk

Copyright: Health Technology Wales