POCUS boosts diagnostic accuracy in patients with acute dyspnoea

Point-of-care ultrasonography (POCUS) improves the accuracy of diagnosis in patients with acute dyspnoea, which is a common and often debilitating symptom with a complex diagnostic work-up, results of a recent study have shown.

The investigators searched multiple electronic databases without language limitations from January 2004 to August 2020, as well as reference lists of pertinent articles and reviews. They identified five randomized controlled trials (RCTs) and 44 prospective cohort studies in patients with acute dyspnoea that assessed POCUS as a diagnostic tool to determine the underlying cause of dyspnoea.

Two investigators independently screened the literature for inclusion. Data abstraction was carried out by the first investigators and confirmed by the second; risk of bias was rated and certainty of evidence determined independently by the researchers.

Adding POCUS to a standard diagnostic pathway resulted in statistically significantly more correct diagnoses in patients with dyspnoea than the standard diagnostic pathway alone. No significant difference was noted in in-hospital mortality and length of hospital stay between patients who did and did not receive POCUS in addition to standard tests.

POCUS consistently improved sensitivities of standard diagnostic pathways to detect the following: pneumonia, pneumothorax, pulmonary embolism, pleural effusion, or congestive heart failure. In addition, specificities increased in most but not all studies.

“Most studies assessed diagnostic test accuracy, which has limited utility for clinical decision making,” the investigators said. “Studies rarely reported on the proportion of indeterminate sonography results, and no evidence is available on adverse health outcomes of false-positive or false-negative POCUS results.”