Point of Care Ultrasound Abdominal Aortic Aneurysm Screening: A Quality Improvement Project

The USPSTF recommends 1-time screening for abdominal aortic aneurysm (AAA) with ultrasonography (US) in men above 65 who have ever smoked. AAA screening has reduced rupture rates; however, the rates of screening are lower in rural areas. The Rural Osteopathic Medical Education program at Texas College of Osteopathic Medicine (TCOM) initiated a quality improvement project to increase rates of AAA screenings by means of medical students equipped with hand-held US devices. Methods: Consenting men above 65 who have ever smoked received an outpatient, point of care ultrasound (POCUS) AAA screening via Butterfly iQ. Screenings of the proximal, middle, and distal portions of the abdominal aorta in both longitudinal and transverse views were conducted. Patients were then referred to radiological services to receive a one-time ultrasound screening for AAA. The outcomes compared the variability between the students' and radiologists' measurements and radiology referral compliance. Results: 35 patients were screened in the clinic using the handheld ultrasound device. 3 patients screened positive for AAA at the radiology department, while 2 screened positive in the clinic. The average difference between the measurements by the students and the radiologists was -0.30 cm (95% CI, -0.45 to -0.15; P=0.0002). Results suggested that there was not a clinically significant difference between measurements obtained by the medical students and the radiology department. The patient follow-up compliance rate was only 51%. Based on these data, medical student performed POCUS AAA screening may provide better compliance with similar accuracy compared to traditional AAA screening.