Written by Megan Hilbert
Spoon Feed
POCUS in the ED can lead to clinically useful information, although research has not yet demonstrated patient-centered improvements in care. While this modality shouldn’t be used for routine screening in the ED, it performs well with a focused clinical question.
Why does this matter?
Over-testing is a hot topic in the current healthcare climate. These two op-eds question whether POCUS is adding to this phenomenon.
POCUS – should we even?
The first article, with its snappy title, hopes to draw attention to, “indications for POCUS and the potential harms associated with potentially indiscriminate use.” It does well to point out benefits and limitations of POCUS and uses asymptomatic AAA screening in the ED as an example. They encourage caution with the decision to use ultrasound in the ED in case it leads to incidental findings, testing, and interventions that end up tilting the balance to harm over benefit.
The second article is a commentary on this initial publication. While the authors agree that we should be careful in use of ultrasound, they contend that asking a focused clinical question can help to find a, “potentially catastrophic but treatable condition if identified promptly at the bedside” – which may ultimately obviate the need for further testing.
These papers aimed to stimulate conversation – and they definitely did! I think the most important takeaway is that POCUS is meant to answer a specific clinical question in a symptomatic patient. Incidentalomas are inevitably going to be found in all imaging modalities. Our job as providers is to consider whether these are clinically relevant and to minimize over-testing where we can.
Sources
- PoCUS: Just because we can doesn’t mean we should. Acad Emerg Med. 2022 Apr;29(4):515-517. doi: 10.1111/acem.14474. Epub 2022 Mar 22.
- Risk-Benefit Analysis of PoCUS for Suspected, Ruptured Abdominal Aortic Aneurysm. Acad Emerg Med. 2022 Apr 14. doi: 10.1111/acem.14506. Online ahead of print.
