Volume Overload? Tools for Rational Assessment

A patient with bilateral peripheral edema develops new dyspnea. Before reaching for a diuretic, how confidently can we establish volume overload at the bedside?

Clinicians have a range of tools to help rule in or rule out volume overload: physical examination, point-of-care ultrasound (POCUS), laboratory tests, and radiologic studies. But how well does each test predict the posttest probability of the diagnosis? In the current systematic review, researchers pooled data from 40 studies evaluating the diagnostic accuracy of tests used to investigate suspected volume overload in 11,500 adults, calculating likelihood ratios for each one (Figure 1). They excluded studies in patients with chronic lymphedema or sepsis and studies in pregnant…