Written by Chris Thom
Spoon Feed
In this single-center retrospective study, POCUS use was associated with a reduction in time to CT acquisition and anticoagulation delivery in patients with acute pulmonary embolism.
Look for the PE before CT
This single-center retrospective study enrolled adult patients who received a CT chest and had a final diagnosis of PE. Study enrollment dates were July 1, 2019 to, June 30, 2022. Time to POCUS, time to CT order, time to CT acquisition, and time to anticoagulation administration were investigated. Times were compared between those patients who received POCUS as part of their care vs. those who did not.
There were 452 patients enrolled, with 73 receiving POCUS and 379 not receiving POCUS. Adjusting for patient demographics and clinical variables, the median time to CT order was 27 minutes shorter in the POCUS cohort (p=0.0097). The adjusted median time to anticoagulation was 49 minutes shorter in the POCUS cohort (p=0.0235).
How will this change my practice?
While the traditional use of echo focuses on risk stratification once the diagnosis of PE is known, using echo for the diagnosis itself is fascinating. The literature is clear that certain echo findings can increase our suspicion for PE prior to CT or VQ imaging. Indeed, certain echo signs can be more specific for PE, such as the McConnell’s sign, which has nearly 100% specificity. In the current study, we see the importance of this “front-end” use of POCUS by ED clinicians, as POCUS utilization was associated with significant reductions in time to CT ordering and anti-coagulation administration.
POCUS pro tips and clips
Pattern recognition and experience can be profoundly helpful when identifying signs of PE on POCUS. Whether it is RV dilation, the “D sign” in the parasternal short axis, abnormal septal motion, or hyperkinesis of the RV apex (McConnell’s sign), having seen normal examples frequently will make you much more reliable in their identification. If you start using POCUS regularly in your chest pain, dyspnea, or hypotensive patients, you will soon gain the pattern recognition to easily and accurately pick these findings out. You can use any echo view for PE assessment, but it is likely that the apical four chamber view is the most reliable in assessing RV:LV size ratio.
Source
The Need for SPEED: Sonography for Pulmonary Embolism in the Emergency Department. J Emerg Med. 2025 Nov;78:258-265. doi: 10.1016/j.jemermed.2025.03.017.
