Point-of-Care Ultrasonography

 

Point-of-care ultrasonography (POCUS) is performed by a physician at the bedside and is standard practice in obstetric, emergency, and musculoskeletal medicine. When compared with formal sonography, POCUS is equivalent in screening for abdominal aortic aneurysm and as accurate in diagnosing deep venous thrombosis. POCUS has high accuracy for diagnosing pneumonia and detecting acute decompensated heart failure but is less accurate than computed tomography for identifying pulmonary embolism. POCUS confirmation of intrauterine pregnancy rules out an ectopic pregnancy. In the third trimester of high-risk pregnancies, umbilical artery Doppler ultrasonography can improve perinatal outcomes. Musculoskeletal POCUS is used to diagnose and guide treatment of many joint and soft tissue conditions. It is as accurate as magnetic resonance imaging in the diagnosis of complete rotator cuff tears. Ultrasound guidance improves outcomes in the placement of central venous catheters and fluid drainage from body cavities and lumbar punctures. Ultrasonography can reduce the use of CT for diagnosis of appendicitis; however, negative scan results do not rule out disease. POCUS can accurately diagnose and rule out gallbladder pathology, and is effective for diagnosing urolithiasis. Focused cardiac ultrasonography can detect pericardial effusion and decreased systolic function, but is less accurate than lung ultrasonography at diagnosing acute heart failure. Limited evidence demonstrates a benefit of diagnosing testicular and gynecologic conditions. The American College of Emergency Physicians, the American Institute of Ultrasound in Medicine, the Society for Academic Emergency Medicine, the American College of Radiology, and others offer POCUS training. Training standards for POCUS have been defined for residency programs but are less established for credentialing.

Point-of-care ultrasonography (POCUS) is an evolving outpatient, inpatient, and urgent care diagnostic tool. Diagnostic timing decreases, and accuracy increases when POCUS augments the clinical examination and procedures. The use of POCUS in primary care is increasing because it reduces cost, radiation exposure, and imaging delays, and increases patient satisfaction. POCUS is also useful in resource-limited settings. The instruction of POCUS is increasing in family medicine residency programs, and resources for practicing physicians exist. However, widespread POCUS use is limited by the training burden required to gain and maintain skills. This article summarizes the strongest evidence for the effectiveness of POCUS in specific clinical conditions.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingComments

Screening for AAA can be performed accurately with POCUS.48

C

Multiple disease-oriented studies; meta-analysis

Lung ultrasonography is accurate for determining the source of acute respiratory distress.2428

C

Disease-oriented studies; systematic reviews

Ultrasonography differentiates cellulitis from abscess more accurately than clinical evaluation and reduces inappropriate incision and drainage and failure to resolve post drainage.17,36

C

Systematic review of eight disease-oriented cohort studies; case-control studies; retrospective review

Ultrasonography can diagnose complete rotator cuff tears with the same accuracy as magnetic resonance imaging.30

C

Cochrane review of 20 disease-oriented studies

POCUS lacks the sensitivity to rule out appendicitis but is diagnostic with a positive scan.39,40

C

Systematic review; meta-analysis

POCUS can rule out ectopic pregnancy by intrauterine pregnancy visualization.55

A

Meta-analysis of 10 studies


AAA = abdominal aortic aneurysm; POCUS = point-of-care ultrasonography.

A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to https://www.aafp.org/afpsort.

The Authors

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MICHAEL J. ARNOLD, MD, FAAFP, is an assistant professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences, Bethesda, Md....

CHRISTOPHER E. JONAS, DO, FAAFP, CAQSM, is an associate professor in the Department of Family Medicine at the Uniformed Services University of the Health Sciences.

RACHEL E. CARTER, MD, MAS, RDMS, is head of the Department of Family Medicine at the Naval Hospital Jacksonville (Fla.), and an assistant professor at the Uniformed Services University of the Health Sciences.

Address correspondence to Michael J. Arnold, MD, FAAFP, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Rd., Bethesda, MD 20814 (email: michael.arnold@usuhs.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliations.

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