ACP: Use point-of-care ultrasound in tandem with standard procedure for acute dyspnea

The ACP has issued a new guideline that recommends clinicians use point-of-care ultrasound along with the standard diagnostic pathway for patients with acute dyspnea when there is diagnostic uncertainty in the ED and inpatient settings.

The standard diagnostic pathway for acute dyspnea includes obtaining medical history, performing a physical exam and requesting blood work, chest or cardiac imaging, ECG and other diagnostic tests, the ACP continued.

More than 1 million ED visits annually are linked to acute dyspnea, according to a press release from the organization.

The recommendation is intended to improve the diagnostic, treatment and health outcomes of patients with suspected congestive heart failure, pneumonia, pulmonary embolism, pleural effusion or pneumothorax. It does not apply to point-of-care ultrasound (POCUS) handheld devices, which lack data on effectiveness, potential harms and diagnostic accuracy, ACP said.

Studies indicated that when used in addition to the standard diagnostic pathway, POCUS increased the proportion of accurate diagnoses by almost one-third, Amir Qaseem, MD, PhD, MHA, ACP’s director of clinical policy, and colleagues wrote in Annals of Internal Medicine.

The recommendation is based on several factors, including the accuracy of POCUS’s sensitivity when used in addition to standard diagnostic testing, the unlikeliness of harm when using POCUS and its low cost. However, the recommendation is conditional for several reasons, including the limited and uncertain evidence regarding POCUS’s effect on hospital stays, and the testing protocols and training that surround its use, according to the researchers.

“The appropriate use of POCUS in treating patients in these settings is an important topic for physicians,” Jacqueline W. Fincher, MD, MACP, president of ACP, said in the press release. “As the use of this diagnostic tool continues to see more widespread use, it’s critical to understand the benefits, potential harms and best use as an accurate diagnostic tool.”