Popat Apurva, Harikrishnan Samyuktha, Seby Niran, Sen Udvas, Patel Sagar K, Mittal Lakshay, Patel Mitkumar, Vundi Charitha, Patel Yashasvi, Kumar Ashish, Nakrani Akash A, Patel Mahir, Yadav Sweta
Internal Medicine, Marshfield Clinic Health System, Marshfield, USA.
Internal Medicine, Gulf Medical University, Ajman, ARE.
Cureus. 2024 Jan 16;16(1):e52371. doi: 10.7759/cureus.52371. eCollection 2024 Jan.
Point-of-care ultrasound (POCUS) is an imaging modality that has become a fundamental part of clinical care provided in the emergency department (ED). The applications of this tool in the ED have ranged from resuscitation, diagnosis, and therapeutic to procedure guidance. This review aims to summarize the evidence on the use of POCUS for diagnosis and procedure guidance. To achieve this, CrossRef, PubMed, Cochrane Library, Web of Science, and Google Scholar databases were extensively searched for studies published between January 2000 and November 2023. Additionally, the risk of bias assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 (for studies on the diagnostic role of POCUS) and Cochrane Risk of Bias tool (for studies on the use of POCUS for procedure guidance). Furthermore, diagnostic accuracy outcomes were pooled using STATA 16 software (StatCorp., College Station, TX, USA), while outcomes related to procedure guidance were pooled using the Review Manager software. The study included 81 articles (74 evaluating the diagnostic application of POCUS and seven evaluating the use of POCUS in guiding clinical procedures). In our findings sensitivities and specificities for various conditions were as follows: appendicitis, 65% and 89%; hydronephrosis, 82% and 74%; small bowel obstruction, 93% and 82%; cholecystitis, 75% and 96%; retinal detachment, 94% and 91%; abscess, 95% and 85%; foreign bodies, 67% and 97%; clavicle fractures, 93% and 94%; distal forearm fractures, 97% and 94%; metacarpal fractures, 94% and 92%; skull fractures, 91% and 97%; and pleural effusion, 91% and 97%. A subgroup analysis of data from 11 studies also showed that the two-point POCUS has a sensitivity and specificity of 89% and 96%, while the three-point POCUS is 87% sensitive and 92% specific in the diagnosis of deep vein thrombosis. In addition, the analyses showed that ultrasound guidance significantly increases the overall success rate of peripheral venous access (p = 0.02) and significantly reduces the number of skin punctures (p = 0.01) compared to conventional methods. In conclusion, POCUS can be used in the ED to diagnose a wide range of clinical conditions accurately. Furthermore, it can be used to guide peripheral venous access and central venous catheter insertion.
床旁超声（POCUS）是一种成像方式，已成为急诊科（ED）临床护理的基本组成部分。该工具在急诊科的应用范围涵盖复苏、诊断、治疗及操作引导。本综述旨在总结关于使用床旁超声进行诊断和操作引导的证据。为此，我们广泛检索了CrossRef、PubMed、Cochrane图书馆、科学网和谷歌学术数据库中2000年1月至2023年11月发表的研究。此外，使用诊断准确性研究质量评估2（用于床旁超声诊断作用的研究）和Cochrane偏倚风险工具（用于床旁超声操作引导使用的研究）进行偏倚风险评估。此外，使用STATA 16软件（美国德克萨斯州大学城StatCorp公司）汇总诊断准确性结果，而使用Review Manager软件汇总与操作引导相关的结果。该研究纳入了81篇文章（74篇评估床旁超声的诊断应用，7篇评估床旁超声在引导临床操作中的应用）。在我们的研究结果中，各种病症的敏感性和特异性如下：阑尾炎，65%和89%；肾积水，82%和74%；小肠梗阻，93%和82%；胆囊炎，75%和96%；视网膜脱离，94%和91%；脓肿，95%和85%；异物，67%和97%；锁骨骨折，93%和94%；前臂远端骨折，97%和94%；掌骨骨折，94%和92%；颅骨骨折，91%和97%；以及胸腔积液，91%和97%。对11项研究数据的亚组分析还表明，两点式床旁超声在诊断深静脉血栓形成中的敏感性和特异性分别为89%和96%，而三点式床旁超声的敏感性为87%，特异性为92%。此外，分析表明，与传统方法相比，超声引导显著提高了外周静脉穿刺的总体成功率（p = 0.02），并显著减少了皮肤穿刺次数（p = 0.01）。总之，床旁超声可用于急诊科准确诊断多种临床病症。此外，它还可用于引导外周静脉穿刺和中心静脉导管插入。
