Table 5. PoCUS in the outpatient setting.

ED: Emergency department; OP: Outpatient; LV: Left ventricle; RV: Right ventricle; LAE: Left atrial enlargement; IVC: Inferior vena cava; SN: Sensitivity; SP: Specificity; MACE: Major adverse cardiovascular events; PE: Pulmonary embolism; AAA: Abdominal aortic aneurysm; FAST: Focused assessment with sonography in trauma; PoCUS: Point-of-care ultrasound

Study name, year	Study type	PoCUS use	Study details/outcome	Conclusion
Kovell et al., 2018 [79]	Literature review	- Outpatient: risk stratify and diagnose medical condition- cardiovascular disease - ED, critical care: guide triage and critical care interventions	- Early identification and help direct management decisions - OP setting: 84% 2D echocardiogram pick up 82% abnormal cardiac finding compared to 47% by physical exam - ED: PoCUS had a higher ICU admission rate (80.4 vs. 67.2%), decreased mortality (11% vs. 19.5%), an essential tool to guide the management of shock - ICU: 28-day survival improved 66% vs. 56% standard of care	- PoCUS can be a useful adjunct to physical exams, particularly in critical care applications
Kobal et al., 2016 [80]	Prospective, multi-center	- Triage of cardiac disease by eyeball examination of global and regional wall motion abnormality - Color Doppler to diagnose valve malfunction - Severity of valve regurgitation by jet area - Liner measurements of LV, RV size, LV wall thickness, ascending aorta	- Of 207 OP and inpatients, 56% were males - 71% in ICU, 17% outpatient, 12% floors - After PoCUS, 14% of physicians changed their diagnosis, 9% from cardiac to non-cardiac; 3% changed etiology of cardiac disease, 2% changed from non-cardiac to cardiac - In 52% change of diagnosis or treatment plan, 39% changed assessment to perform another diagnostic study, 5% referred to the therapeutic procedure, 2% decided against the procedure, 8% were hospitalized, 1% discharged - PoCUS helped 48% of patients in triage, 33% with minor contribution, 19% with no impact - 14% change in primary diagnosis, 48% upgrade in diagnosis after PoCUS	- Extension of physical examination with PoCUS by cardiology fellows and cardiologists in the triage of patients with acute cardiac problems resulted in alteration of diagnosis, change in management in >50% of patients, improved the confidence level of physician - PoCUS can prevent unnecessary additional diagnostic studies, guide patient therapy, hospitalization and discharge
Han et al., 2019 [81]	Retrospective	- To refine referral for OP Echocardiography	The referral model has been developed after identifying LAE, age, and diabetes in patients who ultimately showed significant echocardiogram abnormalities and higher long-term mortality - Initial derivation cohort on 233 pts with mean age 63+/- 17 yrs., 45% male, with LAE had 70% accuracy, 58% SN, 78% SP and IVC plethora had 71% accuracy with 34% SN, 94% SP - In the derivation cohort, MACE or death at 5.5 years was 38% abnormal vs. 13% in the normal echocardiogram - Prevalence of LAE, IVC plethora sign and both were 43%,10%, and 7%, respectively - Mortality at 5.5 years was 14.6% overall, and in pts with LAE 23%, IVC plethora sign 25% and 38%. In those lacking both signs, overall mortality was 8%	- Echocardiogram ordered by OP physicians often turns normal - Referral for Echocardiogram after initial screening PoCUS provides prognostic information, is a cost-effective care
Ahmad et al., 2022 [82]	Case Report	- To rapidly diagnose massive PE and DVT in daycare or OP setting	- Left femoral vein thrombus; increased right heart pressure in PoCUS led to the decision to administer fibrinolytic therapy - PoCUS allowed for rapid diagnosis of PE; institution of anticoagulant therapy to save life - PoCUS in lower limb showed absence of doppler signal, lung showed A-profile bilateral means unremarkable, cardiac PoCUS revealed dilated RV, flattening of septal wall, D shaped LV - Lower limb PoCUS helped in increased predictive performance in diagnosing PE	- Lung, lower limb, and cardiac PoCUS helps in identifying PE, especially in hemodynamically unstable patients - PoCUS is a handy tool useful in day-care surgery or OP setting
Frasure et al., 2020 [83]	Literature Review	- Facilitates triage patients; provides diagnostic information quickly in OP, urgent care, or ED - Use for soft tissue infections, gallstones, AAA, kidney stones, intrauterine pregnancy; diagnosis of foreign bodies	- High-frequency transducers (linear probe) used for superficial structures up to 6 cm depth like skin, muscle and bones - Lower frequency probes (phased array, curvilinear transducers) penetrate deeper up to 20-30 cm, used for less detailed and deep structures like AAA - Diagnosis of abscess, especially within cellulitis, cholelithiasis, not only kidney stone but also hydronephrosis, quantification of size of AAA in addition guiding removal of foreign body and identification of intrauterine pregnancy even as early <4 weeks or ectopic pregnancy is possible with PoCUS use - In traumatic conditions, pneumothorax, hemothorax, pericardial effusion, retinal detachment, lens dislocation, and retinal/ vitreous hemorrhage can also be diagnosed with PoCUS - PoCUS reduces the length of stay from 26 minutes to 2 hours; also affordable for urban or rural smaller size facilities like primary care, family medicine or intensive care, internal medicine - Also helpful in performing peripheral intravenous lines, paracentesis, thoracentesis, and lumbar punctures.	- Integration of PoCUS into clinic/outpatient settings is helpful as a bedside tool for diagnosis and expedition of medical treatment.
Hamill et al., 2020 [84]	Prospective	- To diagnose thyroid nodules and goiters by trained non-radiologist	- Total 40 scans between January 2017 and April 2018 with a mean age of 52 years, 30 females, 10 males; indication nodules in 20, goiter in 13, patient preference in 7; British thyroid association classification U scoring U1+U2 in 37 patients, U3-U5 in three patients - Duration of scan 5-7 minutes - All reporting of POCUS performed by endocrinologists reviewed by radiologists - Fine needle aspiration biopsy result Thy1 in 2, Thy2 in 6; Thy 5 in one patient and diagnosis benign in 39 and malignant in one patient	- PoCUS can be useful in terms of same-day scanning, non-invasiveness, cost, and time-saving, expediting diagnosis, easing the burden on radiologists, and enhancing patient satisfaction in endocrine OP settings
Arya et al., 2022 [85]	Retrospective, single-center	- Diagnosis made with POCUS in specialist palliative care setting	- PoCUS was used for 126 conditions in 89 patients - 61 (48.4%) in OP settings; 75% had been diagnosed with cancer - 81 (64.3%) ascites, 21 (16.7%) pleural effusion, 2 (1.5%) bowel obstruction, 1 (0.8%) pneumothorax, and 2 (1.5%) congestive heart failure using PoCUS - 52 paracentesis and 7 thoracentesis performed using PoCUS - 57 (45%) use of PoCUS in the palliative care unit, 30 (24%) in the clinic, 22 (17%) at home, 7 (6%) long-term cancer center	- PoCUS aids in diagnosis management in inpatient and outpatient settings; reduces visits to hospital; decreases the number of hospital deaths; reduces complications of procedures; better symptom control; improves quality of life and patient satisfaction
Rominger et al., 2018 [86]	Prospective, multi-center	- Longitudinal POCUS training provided to physicians in four different sessions over one year for rural physicians in Mexico	- Over 12 months period, 584 ultrasound, 45.5% transabdominal obstetric, 26.6% abdomen/pelvis, 5.7% musculoskeletal, and 5.7% skin and soft tissue examination performed - Use of PoCUS changed the diagnosis in 194 (34%) patients and management changed in 171 (30%) patients	- PoCUS training is a useful tool for rural physician to improve their clinical outcome
Sullivan et al., 2021 [87]	Retrospective, single-center	- As a diagnostic modality in the military for a month-long Brazilian Riverine mission in February 2019	- PoCUS was used in 24 (3%), 88% of females - Of females, 21 (52%) were pregnant; 14 (54%) were pelvic obstetric cases; 3 (12.5%) non obstetric pelvic; 4 (16%) FAST/abdominal examination - Out of 24 who underwent PoCUS examination, 10 (42%) had symptoms; without PoCUS, those patients might have been recommended for evacuation (referral to a higher center) - In each case, PoCUS provided viable intrauterine pregnancy as an explanation of amenorrhea or showed absence of concerning pathology that prevented OP primary care visits	- PoCUS proved an inexpensive, effective tool for preventing unnecessary referrals. It is a benefit advantage of adding PoCUS to humanitarian assistance missions