Point-of-care ultrasound (POCUS): unnecessary gadgetry or evidence-based medicine?

Abstract

Over the last decade there has been increasing interest and enthusiasm in point-of-care ultrasound (POCUS) as an aide to traditional examination techniques in assessing acutely unwell adult patients. However, it currently remains the domain of a relatively small handful of physicians within the UK. There are numerous reasons for this, notably a lack of training pathways and supervisors but also a lack of understanding of the evidence base behind this imaging modality. This review article aims to explore some of the evidence base behind POCUS for a number of medical pathologies, and where possible compare it to evidenced traditional examination techniques. We discuss the issues around training in bedside ultrasound and recommend a push to integrate POCUS training into internal medicine curricula and support trainers to comprehensively deliver this.

Keywords: POCUS; Point-of-care ultrasound; clinical review; diagnostics; ultrasound.

© Royal College of Physicians 2018. All rights reserved.

Figures

Fig 1.

Example images seen during thoracic ultrasound. Clockwise from top left: normal lung appearance with horizontal A line artefacts; vertical B line artefacts seen in a number of conditions; large left pleural effusion with collapsed lung and apex of heart visible; consolidated lung base – the so-called ‘shred sign’ – with small parapneumonic effusion.

Fig 2.

Example images seen during abdominal ultrasound. Clockwise from top left: normal liver and kidney; ascites around liver tip and in Morrison's pouch; thick-walled gallbladder with pericholecystic fluid and a stone in the neck; severe hydronephrosis with dilated ureter and renal cortical thinning.