• Catherine E Varner, Shirley Lee, Shelley McLeod, Erin Bearss, Amita Singwi, Shirley Hu, Negine Nahiddi, and Bjug Borgundvaag.
• Deputy Director and Clinician Scientist with the Schwartz-Reisman Emergency Medicine Institute (SREMI) in the Sinai Health System in Toronto, Ont, an emergency physician with Sinai Health, and Clinician Investigator and Associate Professor in the Department of Family and Community Medicine (DFCM) at the University of Toronto. Catherine.varner@sinaihealthsystem.ca.
• Can Fam Physician. 2022 Nov 1; 68 (11): e326e332e326-e332.

ObjectiveTo evaluate the use of point-of-care ultrasound (POCUS) for the assessment of patients experiencing first-trimester bleeding or abdominal pain by family physicians working in family medicine clinics following first-trimester POCUS training and certification.DesignMultisite, retrospective chart review.SettingTwo hospital-affiliated academic family medicine clinics in Toronto, Ont.ParticipantsTwelve family physicians who completed a first-trimester POCUS training and certification course.Main Outcome MeasuresThe primary outcome was the proportion of family physicians using POCUS during their evaluations of patients in the first trimester of pregnancy in the 6 months following the FPs' successful completion of the Family Medicine Obstetrical Ultrasound (FaMOUS) course. Secondary outcomes included indications for POCUS use, diagnostic accuracy of POCUS compared with radiologist-interpreted ultrasound, pregnancy outcomes, and emergency department visits within 10 days of the index family medicine clinic visit.ResultsOf the 12 certified family physicians, 7 (58.3%) used POCUS during their assessments of first-trimester patients during the study period. The FPs used POCUS with 56 patients for the following indications: 11 (19.6%) had only vaginal bleeding, 5 (8.9%) had only abdominal pain, and 8 (14.3%) had both vaginal bleeding and abdominal pain; the indication for 32 patients (57.1%) was unclear. Forty-six patients (82.1%) underwent a subsequent radiologist-interpreted ultrasound within 10 days of the index POCUS test. Compared with radiologist-interpreted ultrasound, POCUS had a sensitivity of 91.3% (95% CI 79.2% to 97.6%) for documenting intrauterine pregnancy and a sensitivity of 81.4% (95% CI 66.6% to 91.6%) for documenting the presence of fetal cardiac activity.ConclusionFollowing a first-trimester POCUS certification course, family physicians used POCUS for the assessment of first-trimester patients with varying frequency and for indications other than vaginal bleeding or abdominal pain. Further study is needed to assess the clinical impact of office-based POCUS, unforeseen barriers and facilitators to its use, and patient and provider preferences.Copyright © 2022 the College of Family Physicians of Canada.

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