Background: This presentation will describe a novel study started during a sabbatical year in Colombia. It will briefly cover logistics of taking a sabbatical year and then discuss the ongoing project and preliminary results. Dengue, a neglected tropical viral disease transmitted by the Aedes egypti mosquito, is endemic in Colombia and serves as an ideal disease around which to create a research team. An estimated 390 million people are infected each year of the approximately 3 billion at risk worldwide. Symptoms range from no manifestations to widespread plasma leakage, hemorrhage and death. Diagnosis is often made clinically as laboratory tests are slow and often do not elucidate disease severity. Earlier diagnosis and risk-stratification can be achieved with point-of-care ultrasound (POCUS), which can detect plasma leakage as early as the 3rd illness day. While not widely adopted yet, POCUS could improve dengue care in endemic areas such as Cali, Colombia, however policy limits general physicians (GPs) from using POCUS. There is a need to demonstrate that POCUS can be learned quickly and effectively by GPs so that widespread adoption can lead to improved care for dengue patients in ambulatory settings.
Purpose: Determine if GPs can reliably detect plasma leakage using POCUS in dengue patients following targeted training, for use in ambulatory settings in Cali, Colombia. Discuss starting mid-career research including sabbatical, internal and extramural funding and international research team building.
Description: A training protocol, Focused Assessment with Sonography in Tropical Fever (FASTroF), consisting of the most pertinent POCUS findings in dengue was established. The protocol was taught over a week-long didactic and practical training course received by GPs. Afterwards GPs performed and interpreted over 50 ultrasound exams. Interpretations were analyzed to formulate a competency learning curve in FASTroF. Following training, GPs were placed in a level-one hospital where they perform POCUS in suspect dengue patients. Four-hundred and fifty patients with positive serology will be enrolled. Inter-rater agreement using kappa index will be used to determine how reliably newly trained GPs perform compared with expert opinion.
Conclusions: Preliminary learning curves show learner competence in interpretation of pulmonary B-lines, pleural effusion, and hepatorenal, splenorenal, and pelvic ascites. In this proof-of-concept project, training is complete, data acquisition is ongoing and feasibility has been demonstrated. Preliminary data suggests GPs can quickly and effectively reach competency in most FASTroF exams but more training is needed in others. Plasma leakage can be detected early in patients with dengue.