No HOCUS, just POCUS
How good is point-of-care ultrasound (POCUS) in diagnosing dyspnea in the ED? Over 2500 patients with dyspnea were prospectively evaluated with standard ED work up: ECG, CXR, labs, H&P, etc. Prior to completion of these, a separate ED sonographer performed a lung ultrasound, apical 4-view echo, and evaluation of the IVC and made an independent diagnosis on the basis of POCUS. The initial treating ED clinician was blinded to POCUS results. They found POCUS was highly accurate for CHF, whereas standard workup was better for COPD, asthma, and PE. Overall, POCUS and ED assessment had good agreement (Kappa = 0.71). Here's the kicker - POCUS took 24 minutes to get the diagnosis; standard ED workup took 186 minutes. Bear in mind, all POCUS was performed by emergency physicians with at least 2 years of ultrasound experience. A downside of POCUS is it ties up the physician for 20 minutes while performing the ultrasound. Also it's not like we can do one or the other. We still need the standard work up, but POCUS can help us tailor management earlier.
ED POCUS was very accurate for the diagnosis of dyspnea and led to an answer much faster than standard ED workup.
Point-of-Care Ultrasonography for Evaluation of Acute Dyspnea in the ED. Chest. 2017 Jun;151(6):1295-1301. doi: 10.1016/j.chest.2017.02.003. Epub 2017 Feb 16.
Peer reviewed by Thomas Davis.