Portugal
We often think of the Portugal team as a perennial European football powerhouse. Indeed in recent decades the Portuguese have fielded respectable teams and currently have one of the greatest footballers of all time (Cristiano Ronaldo - see Video 1). Their current victories belie the challenges they've faced in the early years of international competition. Overall, Portugal's best finish was 🥉third place in just one World Cup tournament (1966).
To break out of this funk, this year Portugal fields a brilliant competitor for the NephroWorldCup: an interesting use of point-of-care ultrasonography (POCUS) to diagnose peritoneal dialysis (PD) catheter-related infections (Video 1).
PD catheter infections are often clinically diagnosed. Commonly used scoring systems, such as the Exit-site system, help clinicians make an early diagnosis (Figure 1).
Figure 1. Exit-site scoring infection
Video 1. The greatest footballer? Ever?
But there may be another, more objective manner by which exit-site infections can be diagnosed: point-of-care ultrasonography. In this small single-center investigation, investigators used POCUS on sixteen (16) PD patients with suspected peritoneal dialysis-catheter related infection and nine (9) PD patients without evidence for infection to ascertain the diagnostic accuracy of the POCUS.
POCUS was used to identify anechoic structures near the external or internal cuffs (of a double-cuffed catheter) or the catheter tunnel (Figure 2).
Figure 2. Typical anechoic structure suggestive of PD catheter-related infection
All peritoneal catheter-related infections and none of the nine (9) control patients had a positive POCUS test. The area under the receiver operator characteristic curve was 0.60 (95% CI 0.37-0.84) for the exit-site scoring system and 0.91 for POCUS (95% CI 0.73-1.0) (Figure 3).
Figure 3. ROC for exit-site scoring system (with physical exam) (left) and POCUS (right)
Portugal fields an impressive team in this year's Tournament. Despite a (really) small sample size and a single center in which the study was conducted, the ROC for POCUS is impressive and means that Portugal is punching above its scientific class. POCUS is a nascent field of study and whose applicability continues to expand as passionate teams, like Portugal, further its use.
Figure 4. POCUS in Nephrology | Presented at the 2021 American Society of Nephrology annual meeting | Courtesy of Dr. Rolando Claure
