Written by Chris Thom
Spoon Feed
In this meta-analysis involving 3,785 adult penetrating trauma patients, POCUS had high accuracy in the detection of hemopericardium.
Injuries to the heart are visualized with POCUS
This meta-analysis analyzed the test characteristics of POCUS for hemopericardium in penetrating trauma. It incorporated 10 studies for a total of 3,785 adult patients. The authors sought to assess accuracy of POCUS for hemopericardium, along with time metrics associated with POCUS usage and subsequent therapeutic intervention.
POCUS demonstrated a sensitivity of 87% (95%CI 83–99) and specificity of 99% (95%CI 98–99) for the diagnosis of pericardial effusion in these penetrating trauma patients. The average time to diagnosis of an effusion was 12.8 minutes, while the time from POCUS to operative intervention was 7 to 13 minutes. Survival rates of patients with pericardial effusions ranged from 75% to 98%, dependent on the study.
How will this change my practice?
This is one of the core areas where POCUS demonstrated its initial success and ability to impact outcomes. The sensitivity was high and the specificity was exceptional. This should make us confident that POCUS is an accurate tool for this life threatening pathology and can quickly guide management, including rapid operative intervention.
Pro-tips and clips
The subcostal view is often our standard location for the FAST cardiac imaging. However, do not be shy about jumping up to the parasternal long view, as literature has shown that this is associated with higher overall quality than the subcostal view. One of the key complications in our interpretation of hemopericardium is that the fluid is almost always echogenic, due to the clotting of blood that occurs in the confines of the pericardial space. This will lead to areas of clot that can appear to “bounce” within the pericardial space. It also can lead the untrained eye to have difficulty in distinguishing a pericardial fat pad from hemopericardium. The key is to recognize the heterogeneous, stippled appearance of the adipose tissue, as well as its “in sync” movement with the heart. These are telltale signs that you are looking at a standard fat pad and not at hemopericardium.
Source
Point-Of-Care Ultrasound for Rapid Diagnosis and Management of Pericardial Effusion in Penetrating Trauma: A Systematic Review and Meta-Analysis. J Clin Ultrasound. 2025 Sep 21. doi: 10.1002/jcu.70070. Epub ahead of print. PMID: 40977120.
