Point Of Care Ultrasound By Surgeons: A Multicentric Trial (POCUSS Trial)

Ultrasound is extensively used in continental Europe and the United States in the prompt assessment of patients after trauma, or acute abdominal emergencies. The capacity of non-radiology specialists to perform focused point-of-care ultrasound relevant to their field of expertise is gaining acceptability, and it is considered a technological third hand, or even the modern-day stethoscope. Ireland has been slow to adopt this technique, mainly it would seem for medico-legal reasons, and has hitherto pursued a more conservative approach.

This work aims to demonstrate that surgeon-performed point-of-care ultrasound can be successfully implemented in Irish hospitals, with a tailored approach, to the advantage of the Irish Health Service.

The first study in this thesis is focused on surgeon-performed ultrasound in acute biliary disease. Acute cholecystitis is one of the commonest presentations to the on-call general surgeon, be it in Irish hospitals or worldwide. Ultrasound is the mainstay of diagnostic imaging but there can often be delays before an ultrasound can be performed in the radiology department. It would make sense to have the diagnosis made at the bedside along with clinical examination, as is happening in many parts of Europe and in the United States. This can be confirmed in the imaging department if there is any doubt, or if intervention is required.

The second study is aimed at surgeon-performed ultrasound in acute diverticulitis, which can be thought of as a more advanced procedure. Most of patients with acute diverticulitis can be conservatively managed. Computerized tomography (CT) scanning changes management in a very few instances. It is thus intuitive that ultrasound can diminish the number of unnecessary CTs and subsequent radiation exposure, costs and length of hospital stay.