(O-E5) A Needs Assessment of Point-of-care Ultrasound in the Resource-limited Setting of Iquitos, Peru

Objectives: There has been literature describing the use of point-of-care ultrasound (POCUS) in international settings. However little studies exist on the need for POCUS in Peru, specifically the resource-limited Amazon River city of Iquitos. This is an observational study and needs assessment for POCUS in Iquitos.

Background: The city is accessible only by air or river limiting medical access. Patients who require care that cannot be provided within Iquitos require transportation to Lima, Peru. A direct flight to Lima is approximately 1.5 hours.
In resource-limited communities, diagnostic imaging modalities are often confined to x-ray. But nearly 70% of x-ray machines in resource-limited settings are defective or lack the personnel to operate them. With the evolution of ultra-portable ultrasound technology, devices can be easily carried across the globe to boost diagnostic capacity. The health care and diagnostic imaging needs of a community are unique and cannot be assumed.

Methods: The study took place between August 4th through August 7th, 2022, at two clinics in Iquitos, Peru. The clinics were held at the San Martin Church and San Juan Clinic. At the San Martin Church, there was an ultrasound device on site, but it was not being used as there was no one trained to operate and interpret the images. Point-of-care ultrasounds were performed by a radiologist, emergency medicine ultrasound fellow and medical students. Students were supervised by either the radiologist or ultrasound fellow. Curvilinear and linear probes were attached to tablets and images were obtained using the ultrasound application on the device.

A variety of physician specialties including family medicine, emergency medicine, OB-GYN, urology, pediatrics, etc. were on this medical service trip and were independently seeing patients at the clinic. The radiologist and ultrasound fellow created a consensus list of studies they felt were within the scope of their practice and provided this list to the physicians at the clinics. In addition, clinic physicians were provided an ultrasound order form. These were given to patients who would deliver them to the ultrasound team. Physicians would indicate which study they wanted the ultrasound team to perform and the clinical indication.

Results: 72 POCUS studies were performed on 62 patients. The mean age was 41 with a range of 1 to 82 years. 54% of the patients were female and 46% male. 33 renal/bladder studies were performed (45.8% of the total studies performed). 26 renal/bladder studies were normal, and 7 had a sonographic finding. 11 right upper quadrant (RUQ) studies were performed (15.3%). 8 RUQ studies were normal, and 3 had a sonographic finding. 9 prostate studies were performed (12.5%). 5 prostate studies were normal, and 4 had a sonographic finding. 8 OB-GYN studies were performed (11.1%). 2 OB-GYN studies were normal, and 6 had a sonographic finding. 4 scrotal studies were performed (5.6%). 1 study was normal, and 3 had a sonographic finding. 3 focused assessment for free fluid (FAFF) studies were performed (4.2%). 2 FAFF studies were normal, and 1 had a sonographic finding. 2 soft tissue studies were performed (2.8%). 1 soft tissue study was normal, and 1 had a sonographic finding. 2 thyroid studies were performed (2.8%). 1 thyroid study was normal, and 1 had a sonographic finding. Follow up due to POCUS included 3 emergent ED transfers, 1 flight to Lima, 2 patients with expedited follow up.

Conclusions: The use of point-of-care ultrasound in resource-limited settings across the globe has the potential to expand diagnostic imaging capacity and increase access to previously unobtainable medical care. In this observational study, the use of point-of-care was useful in triaging patients to higher level of care, and improved diagnostic accuracy. The relationship with this community is on-going and this needs assessment has provided valuable evidence onto the disease burden and how to best focus resources on future encounters. Future plans include teaching local physicians how to use ultrasound for longitudinal sustainability.

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Funding (Optional): None