Point-of-care ultrasound for general practitioners: a systematic needs assessment

Figures & data

Figure 1. Study flow. Items: scanning modalities and procedures. N:number of panelists in the study.

Table 1. Delphi panelist characteristics (n = 41).

Mean age (SD)	50 (9)
Gender
Male	32
Female	9
Country
Denmark	24
Norway	10
Sweden	6
Finland	1
Ultrasound experience (years)
2–3 years	15
4–5 years	10
>5 years	16
Employment status
Owner	37
Employee	4
Practice location
Rural (most of the patients live in rural areas)	7
Urban (most of the patients live in urban area)	18
Mixed (patients live in both urban and rural areas)	16
Distance to nearest radiological facility where ultrasound services are provided
<10 km	25
10–50 km	11
>50 km	5
Number of doctors working in practice
1	5
2–3	19
4–5	10
>5	7
Average number of ultrasound examinations performed daily
<1	6
1–2	17
3–4	14
>4	4
Ultrasound teaching experience
Yes	19
No	22
On-call duty (medical emergency services)
Yes	21
No	20
Use of POCUS during on-call duties
Yes	17
No	4
Transducers used
Curve-linear (abdominal)	40
Linear	37
Gynecological	30
Phased array (cardiac)	21
3D/4D	4
Hockey stick	2
Type(s) of scanning modalities and procedures performed
Abdominal	39
Urinary tract	38
Obstetrics	36
Abdominal aorta	36
Musculoskeletal	33
Gynecology	32
Softtissue (lumps and bumps)	31
Deep venous thrombosis	29
Ultrasound guided injections	25
Testis	23
Lung	22
Cardiac	19
Thyroid	16
Carotid	12

Table 2. List of scanning modalities and procedures which reached agreement in round 2 (≥67%).

	Agreement	Median Likert score	Range	Mean Likert score	SD
Bladder volume	100%	5	4–5	4.71	0.46
Subcutaneous abscesses	98%	5	3–5	4.49	0.55
Gall stones	98%	5	3–5	4.71	0.51
Hydronephrosis	95%	5	2–5	4.44	0.74
Localization of intrauterine device	95%	5	2–5	4.51	0.68
Living intrauterine pregnancy	93%	5	2–5	4.61	0.77
Fetal position	93%	5	2–5	4.54	0.71
Cholecystitis	93%	5	2–5	4.44	0.78
Localization of foreign body	85%	4	2–5	4.27	0.78
Free abdominal fluid	85%	5	3–5	4.49	0.75
Achilles tendinitis and tendon rupture	85%	4	1–5	4.29	0.87
Bakers cyst	85%	5	1–5	4.37	0.89
Abdominal aortic aneurism	85%	5	2–5	4.41	0.81
First trimester bleeding	85%	5	2–5	4.39	0.86
Deep venous thrombosis	83%	5	2–5	4.37	0.83
Subcutaneous tumors (lipoma, atheroma)	83%	4	2–5	4.27	0.81
Gestational age (CRL measurement)	80%	5	2–5	4.32	1.01
Pericardial effusion	78%	4	2–5	4.10	0.92
Pleural effusion	76%	4	2–5	4.20	0.93
Subacromial/subdeltoid bursitis	76%	4	2–5	4.00	0.95
Ultrasound guided abscess drainage	73%	4	1–5	3.90	1.02
Injection shoulder	73%	4	2–5	4.20	0.90
Varicocele/hydrocele	73%	4	1–5	3.80	1.05
Knee joint effusion	73%	4	3–5	4.20	0.84
Biceps tendinitis, tenosynovitis, and tendon rupture	71%	4	1–5	4.00	0.97
Injection/aspiration, Bakers cyst	68%	4	15	3.95	1.02

Table 3. List of scanning modalities and procedures in round 2, which were carried through to round 3 by level of agreement (percent).

	Agreement^a	Median Likert score	Range	Mean Likert score	SD
Pneumothorax	66% (63%)	4	1–5	3.88	1.00
Extrauterine pregnancy	66% (61%)	4	2–5	3.63	1.04
Ganglion	66% (66%)	4	1–5	3.98	1.01
Injection/aspiration knee joint^b	66% (68%)	4	2–5	4.00	1.00
Rotator cuff tendinitis and/or ruptures (partial or full)^b	66% (78%)	4	1–5	3.85	1.15
Trochanter bursitis^b	63% (68%)	4	1–5	3.63	1.07
Kidney and bladder stones	63% (46%)	4	1–5	3.68	1.08
Fasciitis plantaris	61% (66%)	4	1–5	3.63	0.97
Injection, acromioclavicular joint	61% (61%)	4	2–5	3.85	0.91
Patellar ligament tendinitis	59% (61%)	4	1–5	3.56	1.14
Testicular tumors	56% (37%)	4	1–5	3.46	1.25
Elbow joint effusion^b	56% (68%)	4	1–5	3.51	1.19
Injection, fascia plantaris	56% (54%)	4	1–5	3.63	1.13
Interstitial syndrome (presence of b-lines)	56% (54%)	4	1–5	3.68	1.17
Splenomegaly	56% (39%)	4	1–5	3.37	1.30
Lateral and medial epicondylitis	56% (44%)	4	1–5	3.51	1.00
Uterine fibromas	54% (41%)	4	2–5	3.51	0.84
Injection, epicondylitis (lateral and medial)	51% (46%)	4	1–5	3.66	1.09
Vein puncture (blood sampling)	51% (39%)	4	1–5	3.66	0.94
Estimation of ejection fraction	51% (39%)	4	1–5	3.46	1.14
Pneumonia	51% (44%)	4	1–5	3.54	1.00
Ovarian cysts	51% (46%)	4	2–5	3.54	1.05
Fetal growth (Biparietal diameter, abdominal and head circumference and femur length)	49% (34%)	3	1–5	3.22	1.26
Childhood obstipation (rectal diameter)	49% (46%)	3	1–5	3.51	1.14
Arthrosis acromioclavicular joint	49% (54%)	3	1–5	3.51	1.16
Fractures of long bones (e.g. clavicle, metatarsals, metacarpals, phalanges) and costae	49% (61%)	3	2–5	3.49	0.87
Prostate hypertrophy	46% (29%)	3	1–5	3.32	1.06
Assessment of wall thickness	46% (29%)	3	1–5	3.22	1.13
Mammary cysts	44% (41%)	3	1–5	3.24	1.07
De Quervain tendinitis	44% (41%)	3	1–5	3.32	0.96
Assessment of chamber dimensions	44% (29%)	3	1–5	3.24	1.16
Placenta previa	44% (34%)	3	1–5	3.24	1.16
Hepatomegaly	44% (24%)	3	1–5	3.02	1.17
Thyroid cysts	41% (39%)	3	1–5	3.27	1.12
Bladder Tumor	41% (27%)	3	1–5	3.17	1.34
Hernia	41% (49%)	3	1–5	3.12	1.03
Hip joint effusion	37% (39%)	3	1–5	3.27	1.16
Carotid stenosis	37% (27%)	3	1–5	3.10	1.07
Liver metastases	34% (39%)	3	1–5	2.88	1.42
Quadriceps tendinitis	34% (24%)	3	1–5	3.15	0.85

Note: Agreement in round 3 is shown in parenthesis.

^a Pearson’s correlation coefficient between agreement in round 2 and 3 (r = 0.78).

^b Items are included in the final prioritized list (Table 4).

Table 4. Final prioritized list of scanning modalities and procedures which have gained consensus by level of and importance (mean).

		Mean Likert score	SD	Agreement
1.	Bladder volume	4.71	0.46	100.0%
2.	Gall stones	4.71	0.51	97.6%
3.	Living intrauterine pregnancy	4.61	0.77	92.7%
4.	Fetal position	4.54	0.71	92.7%
5.	Localization of intrauterine device	4.51	0.68	95.1%
6.	Free abdominal fluid	4.49	0.75	85.4%
7.	Subcutaneous abscesses	4.49	0.55	97.6%
8.	Hydronephrosis	4.44	0.74	95.1%
9.	Cholecystitis	4.44	0.78	92.7%
10.	Abdominal aortic aneurism	4.41	0.81	85.4%
11.	First trimester bleeding	4.39	0.86	85.4%
12.	Bakers cyst	4.37	0.89	85.4%
13.	Deep venous thrombosis	4.37	0.83	82.9%
14.	Gestational age (CRL measurement)	4.32	1.01	80.5%
15.	Achilles tendinitis and tendon rupture	4.29	0.87	85.4%
16.	Subcutaneous tumors (lipoma, atheroma)	4.27	0.81	82.9%
17.	Localization of foreign body	4.27	0.78	85.4%
18.	Injection shoulder	4.20	0.90	73.2%
19.	Pleural effusion	4.20	0.93	75.6%
20.	Knee joint effusion	4.20	0.84	73.2%
21.	Pericardial effusion	4.10	0.92	78.0%
22.	Subacromial/subdeltoid bursitis	4.00	0.95	75.6%
23.	Biceps tendinitis, tenosynovitis and tendon rupture	4.00	0.97	70.7%
24.	Injection/aspiration, Bakers cyst	3.95	1.02	68.3%
25.	Rotator cuff tendinitis and/or ruptures (partial or full)	3.93	1.01	78.0%
26.	Ultrasound guided abscess drainage	3.90	1.02	73.2%
27.	Varicocele/hydrocele	3.80	1.05	73.2%
28.	Injection/aspiration knee joint	3.73	1.14	68.3%
29.	Elbow joint effusion	3.71	1.05	68.3%
30.	Trochanter bursitis	3.59	1.05	68.3%