SPOCUS Research Hub

This scoping review summarizes existing literature covering clinical use and educational integration of POCUS by physician assistants. Of 717 studies retrieved, 30 met inclusion criteria. Studies generally demonstrated that PAs can use a fairly wide range of POCUS applications with high accuracy, but POCUS integration into PA programs remains limited because of identified barriers including machine availability and insufficient training opportunities.

Application: Education / Curriculum

This article outlines recommendations for and barriers to the incorporation of bedside ultrasound into PA clinical practice. Advances in technology and increased affordability of machines have allowed ultrasound to become ubiquitous across the spectrum of medical care, yet little formal training exists for physician assistants on this emerging clinical adjunct.

Application: Education / Curriculum

This study determined that after minimal training, Army physician assistants and medics could use portable ultrasound to detect superficial soft tissue abscesses. US examination yielded a sensitivity of 99.2% and specificity of 95.5%, compared to 73.5% sensitivity and 77.2% specificity for clinical examination alone. US changed the diagnosis in 25.4% of all cases.

Application: Soft Tissue / MSK

After brief training, medics demonstrated greater sensitivity to detect pneumothorax using thoracic ultrasound image interpretation compared to physical exam in a simulated combat environment (85.7% vs. 72.4%, p=0.004). Further studies involving medics' ultrasound image acquisition capability in human patients in austere combat environments are warranted.

Application: Pulmonary / Thoracic

After a 2-hour training period, 28 Army medics had a sensitivity and specificity of 73% and 78% detecting 1-3mm foreign bodies utilizing standard ultrasound equipment. Army medics with minimal ultrasound experience successfully identified foreign bodies embedded in hand models with accuracies similar to radiologists and emergency medicine physicians.

Application: Soft Tissue / MSK

This prospective comparative study evaluated glucomannan gel as a field-expedient substitute for commercial ultrasound transmission gel. Despite a high image adequacy rate, glucomannan gel proved inferior to commercial gel for image adequacy but produced equivalent image quality. Glucomannan gel may be a reasonable substitute when commercial gel is unavailable.

Application: Military / Austere Environment

A 4-hour introductory eFAST training intervention can effectively train conventional military medics to perform the eFAST exam. Overall eFAST knowledge improved from a baseline mean of 27% to 83% post-test. Medics demonstrated comparable performance to previously trained emergency medicine resident physicians. Online asynchronous platforms may effectively mitigate resource requirements for POCUS training.

Application: Military / Trauma

Vehicular motion did not affect FAST completion time and diagnostic accuracy; however, it did reduce FAST image acquisition scores. The results suggest timely and diagnostically accurate FASTs may be completed by experienced sonographers during moderate levels of ambulance turbulence.

Application: Military / Trauma

Short-axis imaged approach was associated with a significantly shorter time to cannulation compared to biplane axis imaging approach. No significant differences were noted in first pass success, number of attempts, or posterior wall and arterial wall puncture rates. Further studies are needed to assess the clinical value of novel biplane axis ultrasound imaging in ultrasound-guided procedures.

Application: Procedural Guidance / Vascular

This article describes a novel ultrasound gel alternative that may be better suited for resource-constrained environments than standard ultrasound gel, without compromising image quality. Ultrasound represents an ideal diagnostic adjunct for medical personnel operating in austere environments, because of its increasing portability and expanding number of point-of-care applications.

Application: Military / Austere Environment

Extended FAST exam times were faster with conventional transducers. Combat medics performed diagnostically accurate eFASTs with both transducer types in a simulated aid station setting after a brief training intervention. Diagnostic accuracy was 97.7% vs. 96.0% for conventional versus novel transducers with no statistically significant difference. Conventional transducers were rated higher for ease-of-use.

Application: Military / Trauma

Combat medic eFAST performance utilizing novel and conventional devices did not differ with respect to time to completion, diagnostic accuracy, and technical adequacy. Medics with limited ultrasound experience performed diagnostically accurate eFAST after a brief training intervention. Future research should assess learning gaps and skill retention to guide development of US military ultrasound training programs.

Application: Military / Trauma

Non-physician healthcare providers can accurately detect a pneumothorax with portable ultrasound after receiving minimal focused training. Twenty-two participants achieved a sensitivity of 95.4% and specificity of 100% for pneumothorax detection in a porcine model. This study supports the potential for non-physician providers to use portable ultrasound in combat trauma settings.

Application: Pulmonary / Thoracic

US Army combat medics can use portable ultrasound to detect sonographic findings of pneumothorax in a human cadaver model with high sensitivity after a brief blended training intervention. The blended (didactic and hands-on) cohort detected pneumothorax with sensitivity of 91% and specificity of 80%, compared to 68% and 57% for didactic-only training.

Application: Pulmonary / Thoracic

This systematic review characterizes the learning curves for POCUS psychomotor skill acquisition. Results support recommendations to complete 25-50 examinations per application of POCUS learned. Specific applications such as cardiac and FAST exams require closer to 50, while soft tissue, airway, and eye require no more than 25.

Application: Education / Curriculum

POCUS of the lungs, heart, inferior vena cava, and internal jugular vein can add valuable data for clinicians when determining volume status. Lung ultrasound is more accurate than physical examination and chest radiography in detecting pulmonary edema and pleural effusions; cardiac POCUS allows for qualitative estimations of LV and RV function.

Application: Cardiac / Volume Status

This study defines the psychomotor skill acquisition learning curves of novice PA students and analyzes learning curves for individual image quality components. Bladder POCUS skills can be rapidly acquired and have the shortest learning curve, while cardiac POCUS has the longest. Axis has the longest learning curve of the three image quality components.

Application: Education / Curriculum

A systematic review investigating the use of point-of-care ultrasound and associated clinical outcomes in inpatient perioperative medical management. Studies supported using POCUS to expedite cardiac examination, promptly diagnose postoperative pulmonary complications, and optimize surgical timing. More extensive studies are needed from acute care providers' perspectives.

Application: Perioperative / Cardiac

This article introduces five basic POC ultrasound scans that can easily be mastered by practicing PAs. Clinicians are increasingly becoming familiar with the value of limited, focused point-of-care ultrasonography to help answer discrete clinical questions. Ultrasound education is being taught in medical schools and PA programs nationwide.

Application: General / Multi-system