Table 3. Current utilization spectrum of PoCUS.
cIVC: Inferior vena cava collapsibility; LV: Left ventricle; RV: Right ventricle; COPD: Chronic obstructive pulmonary disease; SP: Specificity; SN: Sensitivity; FEEL: Focused echocardiographic evaluation in life support; SBO: Small bowel obstruction; ED: Emergency department; ECA: Enteric-coated aspirin; PEG: Polyethylene glycol; PIS: Pulmonary interstitial syndrome; ONSD: Optic nerve sheath diameter; LVEDP: Left ventricular end-diastolic pressure; BNP: Brain natriuretic peptide; ECG: Electrocardiogram; ECMO: Extracorporeal membrane oxygenation; EP: Emergency physician; LOS: Length of stay; PoCUS: Point-of-care ultrasound
| Study name, year | Study type | PoCUS use | Study details/outcome | Conclusion |
| Cardiovascular Disorders | ||||
| Corl et al., 2017 [32] | Prospective | - To determine the ability of cIVC to identify spontaneously breathing critically ill patients’ response to additional intravenous fluids administration | - 124 critically ill patients - cIVC detected responsiveness: area under the curve =0.84 (0.76, 0.91) - Optimum cutoff of 25% rather than 40% in cIVC decreased misclassification | - cIVC helped in differentiating non-fluid responders from fluid responders - Can help guide intravenous fluid resuscitation among critically ill patients |
| Colclough et al., 2017 [45] | Prospective, single center | - Comparison between PoCUS use (V scan device) vs. control group performed with randomization - Focus echocardiography within 10 minutes and followed by final diagnosis, length of stay, in-patient mortality, and 30-day mortality | - 52 patients of age >18 years presented with shortness of breath - 33% abnormal scan; 9% LV hypertrophy, 9% moderate and 14% severe impaired systolic LV function, 9% abnormal systolic RV function, 9% had dilated left atrium, right atrium, RV, 14% tricuspid regurgitation, 4% aortic regurgitation, mitral regurgitation, 0% mitral stenosis, aortic root dilation - Final diagnosis of atrial fibrillation in 5%, sepsis 2.5%, 17.5% COPD, 15% Asthma, no abnormality found in 5% | - More feasible for rapid diagnosis, reduced time to diagnose in the emergency department - Improves diagnostic accuracy as an extension of physical examination |
| Emergency and Trauma | ||||
| Breitkreutz et al., 2010 [46] | Prospective | - Cardio-pulmonary resuscitation or in shock state | - 230 patients - 204 FEEL examination [Cardiac arrest (100) + shock state (104)] - 35% of those with an ECG diagnosis of asystole and 58% of those with pulseless electrical activity, coordinated cardiac motion was detected | Echocardiographic findings: - Altered management in 78% of cases - Associated with increased survival |
| Zanobetti et al., 2017 [33] | Prospective | - Evaluation of acute dyspnea | - 2683 patients - Average time needed to reach diagnosis was significantly lower - PoCUS was sensitive for diagnosing heart failure compared to COPD/asthma and pulmonary embolism | PoCUS is reliable for diagnosis of patients with dyspnea - Reduced diagnosis time |
| Nakao et al., 2020 [47] | Prospective | - Clinical impact on patients with acute heart failure and COPD | - 81 patients evaluated by lung PoCUS; 243 matched patients - Evaluated patients received treatment faster | - Faster administration of disease-specific treatment in elderly with suspected COPD or acute heart failure |
| Buhumaid et al., 2018 [48] | Prospective | - Diagnosing the cause of shortness of breath and chest pain - Comparative accuracy with a chest X-ray | - 128 patients with a mean age ± 17 years - Higher SP of PoCUS in all indications except pneumonia as compared to chest X-ray - Pneumothorax, pericardial effusion, and pleural effusion patients were correctly identified | - PoCUS is a highly effective test in the evaluation and diagnosis of chest pain and shortness of breath; narrows down the differential diagnosis - Chest X-ray has minimal clinical value in the setting of routine thoracic ultrasound |
| Becker et al., 2019 [39] | Prospective, multi-center | - Diagnosis of SBO | - 217 patients with an SBO prevalence of 42.9% - PoCUS for SBO showed SP 0.54 (95% CI = 0.45 to 0.63) and SN 0.88 (95% CI = 0.80 to 0.94) - Abnormal peristalsis and small bowel dilation of ≥ 25 mm were sensitive ultrasound parameters - Specific parameters are bowel wall edema, transition point, and intraperitoneal free fluid | - Moderate SN of PoCUS for SBO - Physician emergency ultrasound familiarity and training increase accuracy |
| Akyol et al., 2016 [38] | Prospective | - Diagnosis of shoulder dislocation | - PoCUS SP and SN in identifying dislocation were 84.2% and 100%, respectively - Confirmed reduction in 93 of 94 patients with 100% SP - 100% SN for excluding shoulder fracture, but 84.2% SP | - Effective tool to rule out or rule in shoulder dislocation in ED - High sensitivity for excluding fractures but with false-positive results |
| Weile et al., 2018 [49] | Prospective | - Ultrasound findings in unselected patients | - Positive findings in 39.3% of all patients - 62 positive examinations in 58 unique orthopedic complaint patients - 77 positive examinations among 59 unique patients with medical complaints - 55 positive examinations among 42 unique patients with surgical and abdominal complaints | - Positive PoCUS findings in >1/3rd unselected patients in ED |
| Tzadok et al., 2018 [50] | Observational | - Jugular vein ultrasound for acute dyspnea assessment | - Respiratory area changes of internal jugular vein had 70% accuracy in identifying acute decompensated heart failure in ED | - Ultrasound of internal jugular vein helps diagnose acute decompensated heart failure - Easy to measure and requires little skill; not affected by the habitus of the patient’s body. |
| Gungor et al., 2017 [51] | Prospective | - Acute appendicitis diagnosis | - 264 patients - 169 had a diagnosis of acute appendicitis - SN and SP were 92.3% for PoCUS | - PoCUS performed for diagnosis of acute appendicitis in ED has high SN and SP - Positive impact on clinical decision-making of ED physicians |
| Bothwell et al., 2014 [52] | Prospective | - Impact of decontamination therapy on ingested pills | - 37 ED physicians completed the study - All correctly identified the absence of tablets in bags containing only water - Diagnosed the presence of ECA tablets in bags containing water and PEG - For Part 2 of the study, most participants - 67.5% (25/37) using water, (62.1%) 23/37 using PEG, and all 100% (37) using activated charcoal - underestimated the number of ECA pills in solution by at least 50% | - Potential role of PoCUS in evaluating suspected acute, massive overdose in patients. |
| Graglia et al., 2021 [53] | Prospective | - To validate Bedside Sonographic Acute Cholecystitis (SAC) Score to diagnose acute cholecystitis | - 53 patients; the cutoff of ≥ 4 was used - Bedside SAC Score had an SN and SP of 88.9% and 67.5%, respectively - A Bedside SAC Score of < 2 had SN and SP of 100% and 35%, respectively - A Bedside SAC Score of ≥ 7 had SN and SP of 44.4% and 95.7%, respectively | - For diagnosis of acute cholecystitis, a bedside prediction score has great utility in ED - Rule out low <2 and high >7 scores |
| Prager et al., 2018 [54] | Prospective | - Remote mass gathering with limited resources | - PoCUS was used on 28 of 686 patients treated in medical tents to narrow the differential diagnosis in 64% of cases, alter working diagnosis in 21% of cases, a change management plan in 39% of cases - Reduce the burden on broader healthcare resource utilization in 46% of cases - Prevented ambulance transport off-site in 32% of cases - Absolute risk reduction of 1.3% in hospital-transferred patients | - PoCUS helped improve the diagnosis and management of patients at a remote music festival - Reduced ambulance transfers off-site and burden on healthcare |
| Gynecology and Obstetrics | ||||
| Ortner et al., 2019 [55] | Prospective | - To study the prevalence of cardiac dysfunction, PIS, and increased ONSD among patients with late-onset preeclampsia | - PIS, systolic dysfunction, LVEDP, and diastolic dysfunction were present in 24%, 10%, 25%, and 33% of women - ONSD was increased in 28% of women - No association between suspicious cardiotocography and PoCUS abnormalities - No association between albumin level, PIS, systolic dysfunctions, or raised LVEDP - PIS was associated with raised LVEDP and diastolic dysfunction - BNP levels were associated with diastolic and systolic dysfunction | - Diastolic dysfunction, increased ONSD, and PIS were common in preeclampsia with severe features - As compared to albumin level, cardiac ultrasound abnormalities are more useful for predicting PIS - Raised LVEDP was excluded by the absence of PIS - Cardiac ultrasound abnormalities had an association with BNP levels |
| Kodaira et al., 2021 [37] | Prospective | - Ultrasound findings using hand-held PoCUS | - Highly accurate for detecting free fluid collection in the abdominal cavity - Ultrasound findings are highly reliable for intrauterine pregnancy, cephalic presentation, fetal heartbeat, multifetal pregnancy, and gestational age assessment based on bi-parietal diameter - Least reliable for the detection of placenta previa or low-lying placenta | - Handheld PoCUS findings were found to be reliable in high-volume resource-limited hospitals for detecting urgent pre-specified obstetric findings |
| ICU | ||||
| Lu et al., 2020 [34] | Retrospective | - Management of high-risk patients in cardiac-surgical and cardiac-medical ICU by rescue PoCUS | - rescue PoCUS was performed on 141 patients - Common indications included hypotension, assessment of ECMO, arrhythmias, ventricular assist devices, abnormal pulmonary artery catheter values abnormality, and ischemic ECG - 129 examinations were positive for cardiac pathology - LV and RV dysfunction, hypovolemia, hypervolemia, pericardial effusion, and ECMO malposition were commonly diagnosed pathologies | - rescue PoCUS examination resulted in diverse diagnosis and management changes - 75% of examinations resulted in further interventions, such as fluid resuscitation (13%), diuresis (7%), inotropic support (12%), surgical intervention in the operating room (11%), bedside surgical intervention (4%), ECMO initiation (8%), and ECMO setting adjustment (6%) |
| Chen et al., 2018 [35] | Prospective | - Daily use in morning rounds; improvement in critically ill patients with sepsis | - 129 subjects at tertiary care hospital ICU; 88 in the control; 41 in the intervention group - In Univariate analysis intervention group had more negative fluid balance and shorter durations of mechanical ventilation on day three - In multivariable analysis, PoCUS was associated with a lower risk of prolonged ICU stay (>7 days) | - PoCUS during morning rounds was associated with a shortened duration of length of stay in the ICU and mechanical ventilation |
| Zieleśkiewicz et al., 2015 [56] | Prospective, multi-center | - Diagnostic and therapeutic use of PoCUS | - 1073 PoCUS/day on 709 patients in 145 ICUs - PoCUS served for procedural guidance in 13% of cases and diagnostic assessment in 87% of cases - Therapeutic and diagnostic impact of POCUS examinations were 69 and 84%, respectively | - PoCUS is highly useful for diagnostic assessment - Has a critical impact on the treatment of ICU patients |
| Pulmonology | ||||
| Shetty et al., 2021 [36] | Prospective | - To compare lung ultrasound patterns in third-trimester gravidas with and without preeclampsia | - 262 women with single pregnancies between 32-41 weeks of gestation - Among healthy gravidas, PoCUS was negative for pulmonary interstitial edema - Two patients with preeclampsia and respiratory symptoms had positive findings on PoCUS - One or two B-lines and three B-lines in one lung field in 18.6% of patients with preeclampsia and 11.4% of healthy gravidas were identified | - Lung ultrasound in women with preeclampsia without respiratory symptoms or signs of pulmonary edema are similar to patterns of healthy gravidas - PoCUS can be used to evaluate third-trimester gravidas with respiratory complaints, preeclampsia, or signs of pulmonary edema |
| Musculoskeletal, Skin, and Soft Tissues | ||||
| Crombach et al., 2020 [40] | Prospective | - Diagnostic value of PoCUS in the ankle; 5th metatarsal bone fracture | - 242 patients, with 35 having non-avulsion fractures, were diagnosed by radiograph - SN and SP in detecting fractures were 80% and 90.3%, respectively, by all sonographers;82.8% and 99.2%, respectively, by experts | - PoCUS, together with OAR (Ottawa ankle rules), has better diagnostic value as compared to radiography |
| Knaysi et al., 2020 [41] | Prospective | - Efficacy in detecting suspected skin and soft tissue infections | - 64 suspected patients were enrolled; 29 had PoCUS-proven abscesses, 33 had cellulitis, and 2 were excluded - Additional use of PoCUS had SN of 96.2%, SP of 93.9%, PPV of 92.6% - 10 of 62 patients’ management was changed; the most common change was a new incision and drainage or needle aspiration. | - PoCUS helped to rule in diagnosis and change management in patients with skin and soft tissue infections |
| ENT | ||||
| Gibbons et al., 2020 [42] | Retrospective | - Management of peritonsillar abscess | - Cohort 1 enrolled 48 patients; 12 had PoCUS; Cohort 2 enrolled 114 patients; 89 had PCoUS - EP successfully aspirated 89.1% with PoCUS vs. 24.5% without ultrasound - EP and ENT combined successful aspirations for PoCUS were 99.0% vs. 80.3% for ultrasound - ENT consultation with PoCUS use was 12.9% vs. 65.6% with ultrasound - CT usage with PoCUS was 23.8% vs. 37.7% with ultrasound - Return visits with PoCUS were 3.96% vs. 18.0% with ultrasound | - PoCUS use for peritonsillar abscess treatment improves aspiration, decreases CT consultations, LOS, and return visits |
| Pediatrics | ||||
| Doniger et al., 2018 [43] | Prospective | - PoCUS accuracy in diagnosing appendicitis | - 40 patients aged 2 to 18 years presenting with abdominal pain to pediatric ED - 16 (40%) had pathology-confirmed appendicitis - PoCUS had an SN and SP of 93.8% and 87.5%, respectively - Radiology-performed ultrasound had an SN and SP of 81.25% and 100%, respectively - Radiology-performed and PoCUS examinations had a very good agreement (κ = 0.83, p < 0.0005) - PoCUS identified all patients with an average score > 6 - Overall, the reduction in CT examinations was 55% | - In pediatric patients presenting with clinical concern for acute appendicitis, a staged algorithm that incorporates PoCUS is accurate and has the potential to decrease CT scan utilization |
| Freidman et al., 2019 [44] | Retrospective | - To determine agreement and time difference between PoCUS imaging by pediatric EP compared to radiology department imaging for children | - 75 patients; patients aged 0 to 18 years presenting to tertiary pediatric ED - In 58 of 75 cases, there was an agreement between PoCUS diagnosis and final diagnosis (κ = 0.71; 95% CI, 0.6-0.83) - In 25 of 28 cases, there was agreement in which pediatric EP performed PoCUS examinations with fellowship training in PoCUS (κ = 0.87; 95% CI, 0.72-1.00) - Results for PoCUS were generated in a median of 115 minutes (interquartile range, 68-185) before radiology department imaging results | - PoCUS imaging by pediatric EP for children with neck masses is a promising new POCUS application that may be able to save time in pediatric ED |
| Freidman et al., 2019 [57] | Chart review | To determine the accuracy of PoCUS by pediatric EP | - 120 patients; 12 cases of testicular torsion - For all causes of the acute scrotum, PoCUS agreed with the final diagnosis in 70% (95% CI 62-78%) of cases - More experienced PoCUS users displayed higher agreement with the final diagnosis - PoCUS results have generated a median of 73 minutes (interquartile range 51- 112) before radiology department ultrasound results | - PoCUS by pediatric EP is accurate for detecting testicular torsion in children with acute scrotum and could expedite diagnosis of this time-sensitive condition |
| Lin et al., 2018 [58] | Retrospective | - To determine if ED LOS differed for children who received PoCUS versus radiology-performed ultrasound | - Children presenting to urban pediatric ED between January 2011 and June 2013 with a diagnosis of cellulitis or abscess who underwent soft tissue ultrasound - Among 3094 children with a diagnosis of cellulitis or abscess, 202 underwent a PoCUS, and 118 underwent radiology-performed ultrasound - PoCUS group had a shorter median LOS than the radiology-performed ultrasound group (adjusted median difference 73 min; 95% interquartile range, 93.6 to 52.4) - In a subset of patients discharged from ED, this difference was more pronounced (adjusted median difference 89 min; interquartile range, 109.9 to 68.1) | - Among children presenting to a pediatric ED with superficial skin and soft tissue infections, children receiving PoCUS experienced shorter LOS compared to children receiving radiology-performed ultrasound |