Point of care ultrasound: focus on evidence for a critical appraisal

Abstract

Point-of-care ultrasound (POCUS) refers to a sonographic examination performed directly at the patient's bedside, integrated into clinical reasoning for diagnostic, monitoring, risk stratification, and therapeutic purposes. Its main applications in medical patients include causes of dyspnea, chest pain, abdominal pain, and shock. In dyspnea, a multiorgan POCUS approach allows for the identification of most underlying conditions. Moreover, in acute heart failure and pulmonary embolism, it aids in risk stratification. In chest pain, POCUS supports diagnosis, though in acute aortic syndromes and acute coronary syndrome, it remains part of a broader diagnostic process. For abdominal pain, it is particularly useful in detecting biliary tract diseases, ascites, acute appendicitis, and abdominal aortic aneurysm. Various POCUS protocols assist in identifying different types of shock (distributive, cardiogenic, hypovolemic, and obstructive). Most studies focus on diagnostic accuracy, highlighting valuable sensitivity and specificity in many conditions. While in many cases faster diagnosis has been shown, its efficacy in guiding treatment, reducing length of stay and the impact on mortality is much less defined. Misuse may derive from inadequate image acquisition, interpretation, and clinical integration, thus appropriate training is fundamental to ensure patient safety. Despite significant expansion in residency programs and medical schools over the past decade, barriers such as limited training access for practicing physicians, faculty availability, and longitudinal competency maintenance persist. The fragmented inclusion of POCUS in disease-specific guidelines underscores a delay in recognizing evidence in some cases, but mostly highlights the need for further research and standardization.

Keywords: Bedside ultrasound; Diagnostic accuracy; Echocardiography; Lung ultrasound; Outcomes assessment; Point of care ultrasound; Ultrasound.