ACP Issues Recommendation on Point-of-Care Ultrasound for Patients with Dyspnea

By Amy Orciari Herman

Edited by David G. Fairchild, MD, MPH, and Jaye Elizabeth Hefner, MD

The American College of Physicians, in a new clinical guideline, suggests that clinicians use point-of-care ultrasonography (POCUS) in addition to standard diagnostic tests for adults with acute dyspnea with uncertain diagnosis in the emergency department or inpatient settings.

The recommendation, published in the Annals of Internal Medicine, is considered conditional. It is based on low-certainty evidence, which showed the following for POCUS in addition to standard diagnostics for patients with nonspecific dyspnea:

• Congestive heart failure: POCUS of the lungs alone or with the heart, inferior vena cava, and deep veins correctly identified 79%–100% of patients who had congestive heart failure and 95%–99% who did not.

• Pleural effusion: POCUS of the lungs, heart, inferior vena cava, and deep veins correctly identified 89%–100% of patients who had pleural effusion and 98%–100% of those who did not.

• Pneumonia: POCUS correctly identified 92% of patients who had pneumonia and 63%-98% who did not.

• Pulmonary embolism: POCUS correctly identified 89%–100% of patients who had pulmonary embolism and 95%–100% who did not.

Overall, POCUS increased correct diagnoses by 32% when used in addition to standard diagnostic tests.

The authors note that the recommendation applies to portable ultrasound devices that can be used at the bedside (but not handheld devices).