Point-of-Care Ultrasound by Nonexpert Operators Demonstrates High Sensitivity and Specificity in Detecting
Seth A Hoffman1,2, Sachin N Desai1,3,4, Michael J Sikorski1,4,5,6
1Center for Vaccine Development and Global Health, University of Maryland School of Medicine, Baltimore, Maryland.
The American Journal of Tropical Medicine and Hygiene
|January 10, 2022
Summary
Point-of-care ultrasound (POCUS) shows promise for detecting gallstones in Samoa, aiding chronic Salmonella Typhi carrier identification. Further training is needed for nonexpert operators to improve scan interpretability and diagnostic accuracy.
Area of Science:
- Infectious Diseases
- Medical Imaging
- Public Health
Background:
- Gallstones are present in approximately 90% of chronic Salmonella enterica serovar Typhi (S. Typhi) carriers with persistent gallbladder infection.
- Typhoid fever is endemic in Samoa, with increasing risk factors for gallstone development among adults.
- Household investigations are crucial for detecting chronic S. Typhi carriers following acute typhoid fever cases.
Purpose of the Study:
- To explore the feasibility of using point-of-care ultrasound (POCUS) to detect gallstones in Samoan adults.
- To assess the potential of POCUS in identifying individuals with gallstones during typhoid fever investigations and community screenings.
- To evaluate the performance of minimally trained, nonexpert operators in POCUS scan acquisition and interpretation.
Main Methods:
- Two nonexpert ultrasound operators performed POCUS on 120 Samoan adults across three cohorts.
- Scans were reviewed by a board-certified radiologist to determine interpretability and compare diagnostic accuracy.
- Performance metrics including sensitivity and specificity were calculated against the radiologist's assessment (gold standard).
Main Results:
- 80% (96/120) of POCUS scans were deemed interpretable by the radiologist.
- Nonexpert operators achieved 85.7% sensitivity and 95.5% specificity in detecting gallstones compared to the gold standard.
- A significant proportion (24/120) of scans were uninterpretable, highlighting the need for enhanced operator training.
Conclusions:
- Minimally trained nonexperts can achieve reasonable accuracy using POCUS to diagnose cholelithiasis (gallstones) in Samoa.
- POCUS is a potentially valuable tool, alongside traditional methods, for identifying chronic S. Typhi carriers in community settings.
- Further training for POCUS operators is essential to improve scan quality and maximize the utility of this diagnostic approach.
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