Evidence: Dyspnea

Point-of-Care Ultrasonography in Patients With Acute Dyspnea: An Evidence Report for a Clinical Practice Guideline by the American College of Physicians. Gartlehner et al. Annals of Internal Medicine. July 2021

This review is the first to take a symptom based approach to evaluate the effectiveness and diagnostic accuracy of POCUS in patients with acute dyspnea. When added to a standard diagnostic pathway, POCUS led to statistically significantly more correct diagnoses than the standard diagnostic pathway alone. In-hospital mortality and length of hospital stay did not differ significantly.

Limitations of this meta-analysis included large heterogeneity of the included studies, with marked differences in pre test probability of diagnosis, ultrasound devices used and POCUS protocols. Reference standards for diagnosis in 30% of the included studies were non-blinded, and differences in method for diagnosis were different. This makes it difficult to compare test accuracy results between studies. Other limitations include a large number of included studies with high risk of bias and lack of reporting of indeterminate ultrasound findings in the studies.

Guidelines:

American College of Physicians Guidelines on appropriate use of POCUS in patients with acute dyspnea in the emergency department or in-patient settings. Quaseem et al. Annals of Internal Medicine. July 2021

Summary:

ACP suggests that clinicians may use point-of-care ultrasonography in addition to the standard diagnostic pathway when there is diagnostic uncertainty in patients with acute dyspnea in emergency department or inpatient settings (conditional recommendation; low-certainty evidence)