Study Finds POCUS Helps Physicians Make Timely Decisions

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A study published in?Ultrasound in Medicine and Biology, found that?point-of-care ultrasound?(POCUS) may facilitate quick and accurate decision-making in cases where the patient is?experiencing?chest pain or shortness of breath.?

The research team conducted a small, randomized clinical trial at one hospital, and the results indicated that performing ultrasound exams at the patient’s bedside shortened the treatment period for patients.?Additionally, the study found that doing so also led to a different diagnosis of the patient in 28% of the cases.?

The authors of the study, led by Dr.?Yael Ben-Baruch Golan, an internist at Soroka University Medical Center in Beer-Sheva, Israel, wrote:

“We have found that POCUS assessment, integrated early into the routine care of these patients, led to significantly shorter times to appropriate treatment. The median time to appropriate treatment was shortened by 19 [hours] in patients who underwent a POCUS scan compared with those who did not.”?

To conduct the single-center trial, the researchers enrolled 60 patients who had been admitted to the internal medicine ward with respiratory or cardiovascular abnormalities. Initial examinations?of the patients were performed by emergency physicians and internal medicine physicians and included physical examinations, labs, and medical history.?

Following the initial examination, half of the patients were randomly assigned to the POCUS group. This group underwent bedside ultrasound imaging of their heart, lungs, and inferior vena cava. These images were taken within one hour of patient randomization and within 24 hours of admission into the hospital.?

The researchers?assigned?physicians?who were not part of?the patients’ care teams?to conduct the POCUS screening. The results of the screening were?then?sent to the patients’ primary physicians.??

The authors then reviewed the diagnosis, treatment, and outcome data for all 60 participants in the study one year later. The results revealed that POCUS use?added clinically relevant findings for 79% of patients who underwent beside ultrasound scans. Moreover, 14% of POCUS patients received an additional diagnosis and 28% had their previous diagnosis altered after receiving bedside?ultrasound.??

In addition to these results, the use of point-of-care ultrasound led to other changes. The study found that about one-third of cases which underwent POCUS?led to a change in management strategies. Nearly 35% of these patients underwent additional medical imaging or had their discharge times?changed. 31% of POCUS patients received altered?medication.??

The research team noted?that, although the results looked promising, the clinical trial only took place with a small number of patients at a single facility. In the future, the team hopes to build upon the pilot study with more randomized clinical trials to validate whether point-of-care ultrasound can lead to accurate and timely diagnosis and treatment of patients.??

The authors concluded, “This is the first randomized controlled trial indicating that incorporation of the POCUS exam into the early diagnostic routine workup of patients admitted to the medical ward with chest pain or dyspnea reduces time to appropriate therapy. These results should be further investigated in larger prospective studies to strengthen the evidence that POCUS assessment affects clinical outcomes.”?

It is important to highlight that medical staff performing these exams should adhere to infection control protocols from their facility and the CDC. These include the use of medical gloves?and PPE depending on the condition of the patient.

Additionally, the probe should always be properly cleaned and disinfected with?hospital-grade products?that are safe for ultrasound use, especially when dealing with patients who could be infected with a respiratory virus (such as COVID-19). In general, POCUS exams only require?non-sterile gel.

For more information on infection prevention and control for medical imaging, visit our?best practices page.