Table.
Test Characteristics of Traditional Physical Examination Findings Versus Point-of-Care (POC) Ultrasound Findings for Common Pathologies
| Pathology | Physical Exam Finding | Sensitivity | Specificity | LR+ | LR- | POC Ultrasound Finding | Sensitivity | Specificity | LR+ | LR- |
| Pleural effusion | Dullness to percussion | 89% | 81% | 4.8 | 0.1 | Pleural fluid visualization | 93% | 96% | 23 | 0.07 |
| Decreased breath sounds | 88% | 83% | 5.2 | 0.1 | ||||||
| Pulmonary edema | Crackles | 19%–64% | 82%–94% | 3.4 | NS | B lines (bilateral) | 94% | 92% | 10.4 | 0.06 |
| Pneumonia | Bronchial breath sounds | 14% | 96% | 3.3 | NS | Consolidation pattern | 94%–95% | 90%–96% | 13.5 | 0.06 |
| Egophony | 4%–16% | 96%–99% | 4.1 | NS | ||||||
| Crackles | 19%–67% | 36%–94% | 1.8 | 0.8 | ||||||
| Elevated LV pressure | Fourth heart sound | 37%–71% | 50%–70% | NS | NS | PCWP 17 if IVC > 2.0 | 75% | 83% | 4.4 | 0.3 |
| Elevated CVP > 8 cm H2O | Neck vein inspection | 47%–92% | 93%–96% | 9.7 | 0.3 | For CVP > 10 mm Hg: IVC size > 2 cm | 73% | 85% | 4.9 | 0.32 |
| Reduced ejection fraction < 50% | Third heart sound | 11%–51% | 85%–98% | 3.4 | 0.7 | LV systolic dysfunction | 84%–91% | 85%–88% | 6.5 | 0.14 |
| Congestive heart failure | Crackles | 12%–23% | 88%–96% | NS | NS | B lines, bilateral | 97% | 95% | 19.4 | 0.03 |
| Elevated JVP | 10%–58% | 96%–97% | 3.9 | NS | For CVP > 10 mm Hg: IVC size > 2 cm | 73% | 85% | 4.9 | 0.32 | |
| Abdominojugular test | 55%–84% | 83%–98% | 8.0 | 0.3 | ||||||
| Edema | 10% | 93%–96% | NS | NS | ||||||
| Ascites | Bulging flanks | 73%–93% | 44%–70% | 1.9 | 0.4 | Ascites visualization | 96% | 82% | 32 | 0.04 |
| Flank dullness | 80%–94% | 29%–69% | NS | 0.3 | ||||||
| Shifting dullness | 60%–87% | 56%–90% | 2.3 | 0.4 | ||||||
| Fluid wave | 50%–80% | 82%–92% | 5.0 | 0.5 | ||||||
| Lower extremity DVT | Calf swelling > 2 cm | 61%–67% | 69%–71% | 2.1 | 0.5 | Compression venous ultrasonography | 96% | 97% | 32 | 0.04 |
| Homan's sign | 10%–54% | 39%–89% | NS | NS | ||||||
| Wells score (high probability) | 38%–87% | 71%–99% | 6.3 | NA |
Note: Table adapted from Reference 13 (Bhagra et al 2016).
Abbreviations: NS, not significant; LV, left ventricle; PCWP, pulmonary capillary wedge pressure; IVC, inferior vena cava; CVP, central venous pressure; JVP, jugular venous pressure; DVT, deep vein thrombosis.