ACP Recommends Use of Point-of-Care Ultrasonography to Improve Diagnosis of Patients With Acute Dyspnoea
By Denise Baez
The American College of Physicians (ACP) has published new guidelines recommending point-of-care ultrasonography (POCUS), in addition to the standard diagnostic pathway, when there is diagnostic uncertainty in patients with acute dyspnoea in emergency department or inpatient settings.
“The rationale to add POCUS to the standard diagnostic pathway is largely based on diagnostic accuracy studies and encompasses several considerations,” wrote Amir Qaseem, MD, ACP, Philadelphia, Pennsylvania, and colleagues. “First, POCUS increased the proportion of correct diagnoses by 32% when used in addition to the standard diagnostic pathway. Second, the test accuracy, particularly sensitivity, of standard diagnostic testing with the addition of POCUS is better than the test accuracy of standard diagnostic pathway alone without a substantial trade-off in specificity. The test accuracy of POCUS is generally acceptable, particularly for diagnosis of congestive heart failure or pleural effusion, although the usefulness of POCUS varies somewhat according to the underlying disease. Third, it is unlikely that POCUS is directly associated with serious harms. Finally, POCUS is not a high-cost test.”
The guideline, published in the Annals of Internal Medicine, was based on data from a systematic review of 5 randomised controlled trials and 44 prospective cohort-type studies. Depending on indication and protocol, low-certainty evidence showed that sensitivities of POCUS in addition to the standard diagnostic pathway ranged from 79% to 100% and specificities ranged from 63% to 100%, compared with sensitivities of standard diagnostic pathway alone ranging from 0% to 83% and specificities ranging from 68% to 100%.
In-hospital mortality and length of hospital stay did not differ significantly between patients who did or did not receive POCUS in addition to standard diagnostic tests.
“As with any diagnostic test, this recommendation applies to clinical scenarios where there is diagnostic uncertainty,” the guideline authors stressed. “Clinicians should understand and consider that the test accuracy of POCUS varies according to the likelihood of underlying diseases.”
The recommendation does not apply to handheld devices. In addition, clinicians who use POCUS should be trained in the use and interpretation of findings and ongoing care quality assessment, the guideline stated.
SOURCE: Annals of Internal Medicine