A Retrospective Analysis of Soft Tissue Point-of-Care Ultrasound (POCUS) in Primary Care

Soft tissue concerns are common, yet most primary care physicians must refer patients to radiology for further imaging, leading to potential delays in diagnosis and management. Point-of-care ultrasound (POCUS) is increasingly available in primary care and has been shown to improve clinical decision making. However, current Family Medicine POCUS curricula focus primarily on cellulitis and abscess, overlooking other common soft tissue pathologies. This study aims to evaluate the frequency of soft tissue pathologies and associated follow-up recommendations on comprehensive radiology ultrasound exams ordered by Family Medicine physicians.

A retrospective study of radiology-performed comprehensive ultrasound exams ordered by an academic urban Family Medicine practice over the course of the 2019 was performed. Data collected included patient demographics, ultrasound findings, anatomic location, and follow-up recommendations. Diagnoses were categorized, and time from order to completion was calculated.

Soft tissue ultrasounds comprised 10% (n = 168) of all ultrasound studies ordered. The most common diagnosis were lymph nodes, n = 44 (25%), lipomas n = 32 (18%), and no lesion/normal n = 23 (13%). Only 2 studies diagnosed abscess (1%). The median time from order date to completion was 6 days (IQR 2 to 22 days), with 48% waiting over a week. Half (51%) of studies required no further follow up, while 26% required additional imaging or biopsy.

These findings highlight the need for expanded Family Medicine POCUS training to include high-yield diagnoses such as lipomas, lymph nodes, and cysts. POCUS could reduce unnecessary referrals, expedite care, and improve diagnostic confidence. Future research should explore primary care-specific POCUS protocols and their impact on patient outcomes.