Evaluation of a novel handheld point-of-care ultrasound device in an African emergency department

Abstract

Background: Many point-of-care ultrasound devices are now "pocket-sized" or handheld, allowing easy transport during travel and facilitating use in crowded spaces or in austere low-resource settings. Concerns remain about their durability, image quality, and clinical utility in those environments.

Method: Five emergency physicians with training in point-of-care ultrasound employed the Butterfly iQ, a novel handheld ultrasound device, in routine clinical care in a busy, high-acuity African emergency department over a period of 10 weeks. We retrospectively evaluated the performance of the Butterfly iQ from the perspectives of both the clinicians using the device and expert ultrasound faculty reviewing the images.

Results: We found advantages of the Butterfly iQ in a high-acuity African emergency department include its use of a single probe for multiple functions, small size, ease of transport, relatively low cost, and good image quality in most functions. Disadvantages include large probe footprint, lower, though still adequate, cardiac imaging quality, frequent overheating, and reliance on internet-based cloud storage, but these were surmountable. We also report a wide variety of patient presentations, pathology, and procedures to which the device was used.

Conclusion: We conclude the Butterfly iQ is an effective, though imperfect, point-of-care ultrasound device in a low-resource emergency setting. We will continue to employ the device in clinical emergency care and teaching in this setting.

Keywords: Butterfly iQ; Emergency; Handheld; Point-of-care ultrasound; Resource-limited settings; Tropical infectious disease.

Fig. 1.

3-month-old male presenting with acute respiratory distress. POCUS revealed a dilated right atrium and ventricle with a prominent atrial septal defect, seen in parasternal long view (left) and a slightly modified apical four chamber view (right). LA, Left Atrium, LV, Left Ventricle, RA, Right Atrium, RV, Right Ventricle, *, Atrial Septal Defect

Fig. 2

Abdominal point-of-care ultrasound of a previously healthy 3-year-old male with abdominal pain, nausea, and vomiting diagnosed with intussusception, confirmed and treated by air contrast enema. a reveals a stereotypical “target sign”, hyperechoic compressed inner loop of bowel (*) telescoping within a hypoechoic, edematous outer loop (arrow). b reveals the target sign in another cross sectional plane, with multiple layers of telescoping bowel

Fig. 3

Musculoskeletal ultrasound of a young male patient with blunt trauma demonstrating two separate sections of tibial cortex (t), with displacement (arrows). Note the associated fracture hematoma visualized (*)