A clinical question.
A focused examination.
Point-of-care ultrasound extends the clinical examination to answer a specific question during patient care.
Point-of-care ultrasound
The clinician uses ultrasound to help answer a question arising from the patient’s history and physical examination. Findings are interpreted alongside other clinical information: they do not, on their own, establish a diagnosis. [1]
The musculoskeletal system
This includes muscles, tendons, joints and surrounding tissues. A focused approach differs from a systematic ultrasound examination in the question being asked and the scope of the examination.
After examining a painful shoulder, the doctor may have a question about a tendon. Point-of-care ultrasound then focuses on that question. It may support the initial hypothesis, change it or leave uncertainty unresolved.
The protocol criteria remain the reference for deciding whether a patient can be enrolled in ECHOSTEOM.
Documenting clinical practice.
Without assuming the outcome.
Starting with the limits of a specific diagnostic question
Reviews of shoulder examination show variable performance for some individual clinical tests. The Hegedus review does not establish that all clinical examination is unreliable. The history, combinations of findings and clinical context remain essential. [3]
Studies on the long head of the biceps tendon and knee effusions address clearly defined indications. They help clarify the value of imaging in these situations; on their own, they do not demonstrate a benefit from every use of point-of-care ultrasound in general practice. [4] [5]
Studying ultrasound in its real-world setting
Reviews of point-of-care ultrasound describe encouraging uses and performance. However, they bring together different indications, levels of training and care settings. Findings from emergency departments cannot automatically be applied to general practice. [1] [2]
The review by Andersen and colleagues highlights methodological limitations in the available studies and the need for research on training, examination quality and patient outcomes. This uncertainty supports the collection of data specific to primary care. [2]
Distinguishing perceived benefit from demonstrated benefit
In a qualitative study, 13 Danish general practitioners described the place of ultrasound in their practice and the advantages they perceived. These interviews help explain their use of ultrasound and their motivations. They do not measure reductions in costs, emergency admissions or additional investigations. [6]
How does musculoskeletal point-of-care ultrasound contribute to general practitioners’ overall clinical decision-making in patients with suspected musculoskeletal abnormalities?
Comparing before and after,
during the consultation.
ECHOSTEOM is a multicentre pilot study in primary care. Developed from Dr Joris Dereant’s thesis, it uses a before-and-after comparison of the doctor’s clinical decision-making.
- 01
Before ultrasound
Describe the clinical situation and initial management plan using the data collection process specified in the protocol.
- 02
After point-of-care ultrasound
Document what the examination contributes to this plan, including when it does not change it.
- 03
Across the study
Analyse data collected from enrolled patients to address the objectives defined in advance.
A change in a clinical decision is not, in itself, evidence of a better patient outcome. A before-and-after design can describe changes; without a randomised comparator group, it is insufficient to establish a causal effect or a long-term benefit.
This website presents the main features of the project. Participation arrangements, eligibility criteria and data collection requirements are those in the protocol provided to investigators.
The same question.
A shared ambition.
“We therefore hypothesise that musculoskeletal point-of-care ultrasound contributes to improving patient management and referral.”
This wording, translated from the project presentation, expresses a research hypothesis. Patient enrolment is ongoing; the website does not yet present ECHOSTEOM results.
The study may provide evidence about the place of point-of-care ultrasound in clinical decision-making, clarify questions to investigate and inform future research. Implications for training, the organisation of care or recognition of the procedure will need to be discussed in light of the results and their limitations.
How is the study progressing? ↗Understanding the study.
Is an ultrasound examination that does not change a decision still useful for research?
Yes. Documenting the absence of a change also helps us understand the contribution of the examination. Enrolment must follow the protocol criteria, without selecting only cases in which ultrasound changes patient management.
Has the study already demonstrated its hypothesis?
No. Enrolment is ongoing. The counter shows progress in patient recruitment; it does not indicate scientific findings.
Where can I find the protocol and data collection tools?
They are provided to investigators by the study team. For access details or documents, contact the ECHOSTEOM team.
Key publications.
An annotated selection of publications used to explain the study rationale. It is not an updated systematic review of the entire literature.
Sorensen B, Hunskaar S. Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations. The Ultrasound Journal. 2019;11:31.
A review of ultrasound use across varied clinical settings and indications.
Andersen CA, Holden S, Vela J, Rathleff MS, Jensen MB. Point-of-Care Ultrasound in General Practice: A Systematic Review. Annals of Family Medicine. 2019;17(1):61–69.
51 articles: promising findings, but frequently limited methodological quality.
Hegedus EJ, Goode A, Campbell S, et al. Physical examination tests of the shoulder: a systematic review with meta-analysis of individual tests. British Journal of Sports Medicine. 2008;42(2):80–92.
Several individual shoulder tests have limited performance; this does not invalidate the clinical examination as a whole.
Bélanger V, Dupuis F, Leblond J, Roy JS. Accuracy of examination of the long head of the biceps tendon in the clinical setting: A systematic review. Journal of Rehabilitation Medicine. 2019;51:479–491.
An analysis focused on the long head of the biceps tendon, to be interpreted according to the suspected lesion.
Meyer R, Lin C, Yenokyan G, Ellen M. Diagnostic Utility of Ultrasound Versus Physical Examination in Assessing Knee Effusions: A Systematic Review and Meta-analysis. Journal of Ultrasound in Medicine. 2022;41(1):17–31.
A specific diagnostic question: identifying a knee effusion.
Andersen CA, Davidsen AS, Brodersen J, Graumann O, Jensen MB. Danish general practitioners have found their own way of using point-of-care ultrasonography in primary care: a qualitative study. BMC Family Practice. 2019;20:89.
Interviews with 13 general practitioners: perceptions and practice, without comparative evidence of cost reductions.