Search Results (143)

Introduction: Sarcopenia is a systemic condition linked to increased morbidity and mortality in older adults. Point-of-Care Ultrasound (POCUS) offers a rapid, bedside method to assess muscle mass. This study evaluates the diagnostic accuracy of POCUS compared to Dual-energy X-ray Absorptiometry (DXA), the gold standard method, and explores its prognostic value in old patients undergoing surgery for hip fractures. Patients and Methods: In this prospective, single-center study, 126 patients aged ≥ 70 years and hospitalized with hip fractures were included. Sarcopenia was defined according to the revised 2018 EWGSOP2 criteria. Muscle mass was assessed by the Appendicular Skeletal Muscle Mass Index (ASMI) using DXA and by the thickness of the rectus femoris (RF) muscle using POCUS. Results: Of the 126 included patients, 52 had both DXA and POCUS assessments, and 43% of them met the diagnostic criteria for sarcopenia or severe sarcopenia. RF muscle thickness measured by POCUS was significantly associated with ASMI (R² = 0.30; p < 0.001). POCUS showed a fair diagnostic accuracy in women (AUC 0.652) and an excellent accuracy in men (AUC 0.905). Optimal diagnostic thresholds according to Youden’s index were 5.7 mm for women and 9.3 mm for men. Neither RF thickness, ASMI, nor sarcopenia status predicted mortality or major postoperative complications. Conclusions: POCUS is a promising, accessible tool for diagnosing sarcopenia in old adults with hip fractures. Nonetheless, its prognostic utility remains uncertain and should be further evaluated in long-term studies. Full article

Background: Necrotizing enterocolitis (NEC) is a severe gastrointestinal disease and a major cause of morbidity and mortality among preterm infants. Traditional diagnostic methods such as abdominal radiography have limited sensitivity in early disease stages, prompting interest in bowel ultrasound (BUS) as a complementary imaging modality. Objective: This scoping review aims to synthesize existing literature on the role of ultra sound in the early detection, diagnosis, and management of NEC, with emphasis on its diagnostic performance, integration into clinical care, and technological innovations. Methods: Following PRISMA-ScR guidelines, a systematic search was conducted across PubMed, Embase, Cochrane Library, and Google Scholar for studies published between January 2000 and December 2025. Inclusion criteria encompassed original research, reviews, and clinical studies evaluating the use of bowel, intestinal, or Doppler ultrasound in neonates with suspected or confirmed NEC. Data were extracted, categorized by study design, population characteristics, ultrasound features, and diagnostic outcomes, and qualitatively synthesized. Results: A total of 101 studies were included. BUS demonstrated superior sensitivity over radiography in detecting early features of NEC, including bowel wall thickening, portal venous gas, and altered peristalsis. Doppler ultrasound, both antenatal and postnatal, was effective in identifying perfusion deficits predictive of NEC onset. Neonatologist-performed ultrasound (NEOBUS) showed high interobserver agreement when standardized protocols were used. Emerging tools such as ultra-high-frequency ultrasound (UHFUS) and artificial intelligence (AI)-enhanced analysis hold potential to improve diagnostic precision. Point-of-care ultrasound (POCUS) appears feasible in resource-limited settings, though implementation barriers remain. Conclusions: Bowel ultrasound is a valuable adjunct to conventional imaging in NEC diagnosis. Standardized protocols, validation of advanced technologies, and out come-based studies are essential to guide its broader clinical adoption. Full article

Background and Objectives: During pandemics, emergency departments face the challenge of managing critically ill patients with limited resources. Point-of-Care Ultrasound (POCUS) has emerged as a crucial diagnostic tool in such scenarios. This study aimed to develop a standardized POCUS protocol using expert consensus via a modified Delphi survey to guide physicians in managing these patients more effectively. Materials and Methods: A committee of emergency imaging experts and board-certified emergency physicians identified essential elements of POCUS in the treatment of patients under investigation (PUI) with shock, sepsis, or other life-threatening diseases. A modified Delphi survey was conducted among 39 emergency imaging experts who were members of the Korean Society of Emergency Medicine. The survey included three rounds of expert feedback and revisions, leading to the development of a POCUS protocol for critically ill patients during a pandemic. Results: The developed POCUS protocol emphasizes the use of POCUS-echocardiography and POCUS-lung ultrasound for the evaluation of cardiac and respiratory function, respectively. The protocol also provides guidance on when to consider additional tests or imaging based on POCUS findings. The Delphi survey results indicated general consensus on the inclusion of POCUS-echocardiography and POCUS-lung ultrasound within the protocol, although there were some disagreements regarding specific elements. Conclusions: Effective clinical practice aids emergency physicians in determining appropriate POCUS strategies for differential diagnosis between life-threatening diseases. Future studies should investigate the effectiveness and feasibility of the protocol in actual clinical scenarios, including its impact on patient outcomes, resource utilization, and workflow efficiency in emergency departments. Full article

The development of new diagnostic technologies is accelerating, and budgetary constraints in the health sector necessitate a systematic decision-making process to acquire emerging technologies. Health Technology Assessment methodologies integrate technology, clinical efficacy, patient safety, and organizational and financial factors in this context. However, these methodologies do not include the learning curve, a critical factor in operator-dependent technologies. This study presents an evaluation model incorporating the learning curve, developed from the domains of the AdHopHTA project. Using System Dynamics (SD), the model was validated and calibrated as a case study to evaluate the use of Point-of-Care Ultrasound (POCUS) in identifying dengue. This approach allowed for the analysis of the impact of the learning curve and patient demand on the revenues and costs of the healthcare system and the cost–benefit indicator associated with dengue detection. The model assesses physician competency and how different training strategies and frequencies of use affect POCUS adoption. The findings underscore the importance of integrating the learning curve into decision-making. This study highlights the need for further investigation into the barriers that limit the effective use of POCUS, particularly in resource-limited settings. It proposes a framework to improve the integration of this technology into clinical practice for early dengue detection. Full article

Background: Obstructive Sleep Apnea (OSA) is a common occurrence in the perioperative patient population but is often undiagnosed. Point-of-Care Ultrasound (POCUS) has emerged as a promising tool for perioperative assessment; however, its effectiveness in detecting the presence or severity of OSA needs to be evaluated. Objective: We assessed the ability of airway POCUS as a screening and severity evaluation tool for OSA by examining its correlation with STOP-BANG scores and the Apnea–Hypopnea Index (AHI). Design: Cross-sectional observational study. Setting: A single-center study in a tertiary care hospital between June 2020 to May 2021. Patients: Adult patients aged 18–65 with prior Polysomnography (PSG) for OSA workup were screened. Interventions: The participants completed the STOP-BANG questionnaire and subsequently underwent POCUS examinations, either pre- or post-surgery. Ten different POCUS views previously used for evaluating OSA were acquired in a predefined sequence, with subsequent measurements of airway parameters. Outcome measures: Generalized linear modeling was used to explore and assess the relationships between the measured parameters, STOP-BANG, and AHI scores (modeled continuously and categorized into risk levels of STOP-BANG and AHI). Results: A total of 260 patients were screened, of which 142 were enrolled and 127 completed the scanning studies. The median AHI was 16.71, while the STOP-BANG scores were mostly between 5 and 6, indicating a moderate-to-high OSA risk in the study population. Notably, only neck circumference was significantly associated with AHI severity (p = 0.012), whereas none of the other POCUS measures were. Among the POCUS measures, significant associations with STOP-BANG scores were observed for the Tongue Cross-Sectional Area (T-CSA) (p = 0.002), Retro-Palatal Diameter (RPD) (p = 0.034), Distance Between Lingual Arteries (DLA) (p = 0.034), and Geniohyoid Muscle Thickness (GMT) (p = 0.040). Conclusions: Neck circumference is a more reliable predictor of OSA severity (AHI) compared to other POCUS measurements. Many of the POCUS measures had a good correlation with the STOP-BANG scores, highlighting the utility of POCUS as a screening tool for OSA rather than as a severity evaluation tool. Full article

Thoracic injuries account for a high percentage of combat casualty mortalities, with 80% of preventable deaths resulting from abdominal or thoracic hemorrhage. An effective method for detecting and triaging thoracic injuries is point-of-care ultrasound (POCUS), as it is a cheap and portable noninvasive imaging method. POCUS image interpretation of pneumothorax (PTX) or hemothorax (HTX) injuries requires a skilled radiologist, which will likely not be available in austere situations where injury detection and triage are most critical. With the recent growth in artificial intelligence (AI) for healthcare, the hypothesis for this study is that deep learning (DL) models for classifying images as showing HTX or PTX injury, or being negative for injury can be developed for lowering the skill threshold for POCUS diagnostics on the future battlefield. Three-class deep learning classification AI models were developed using a motion-mode ultrasound dataset captured in animal study experiments from more than 25 swine subjects. Cluster analysis was used to define the “population” based on brightness, contrast, and kurtosis properties. A MobileNetV3 DL model architecture was tuned across a variety of hyperparameters, with the results ultimately being evaluated using images captured in real-time. Different hyperparameter configurations were blind-tested, resulting in models trained on filtered data having a real-time accuracy from 89 to 96%, as opposed to 78–95% when trained without filtering and optimization. The best model achieved a blind accuracy of 85% when inferencing on data collected in real-time, surpassing previous YOLOv8 models by 17%. AI models can be developed that are suitable for high performance in real-time for thoracic injury determination and are suitable for potentially addressing challenges with responding to emergency casualty situations and reducing the skill threshold for using and interpreting POCUS. Full article

Background/Objectives: Ultrasonography is a diagnostic modality characterized by high sensitivity in detecting hepato-biliary pathology, particularly intrahepatic biliary duct dilation. This study compares the sonographic findings obtained by a radiographer/sonographer in a Basic Emergency Service (BES) using Point-of-Care Ultrasonography (POCUS) in Portugal with the sonographic findings from the same patients acquired by radiologists at a referral hospital (RH) for suspected intrahepatic biliary dilatation. Methods: Nineteen patients presenting with right upper quadrant (RUQ) pain and suspected abdominal pathology underwent sonographic screening using POCUS in the BES. Subsequently, the same patients were referred to the RH, where a radiologist performed a comprehensive ultrasound. Both examinations were compared to determine whether the findings obtained in the BES were confirmed by radiologists in the RH. Results: Cholestasis, cholangitis, lithiasis, pancreatitis, peri-ampullary lithiasis, and neoplasms were observed in association with intrahepatic biliary dilation in this study sample. All six variables showed a strong association between the BES and RH findings (Cramer’s V > 0.6; p < 0.006). A strong kappa measure of agreement between the radiographer and radiologist findings was obtained in “cholelithiasis/sludge/gallbladder acute sonographic changes” (k = 0.802; p = 0.000). A moderate kappa value was obtained for the variable “abdominal free fluid”, (k = 0.706; p = 0.001). Conclusions: In this study, all patients referred from the BES to the RH required hospitalization for treatment and additional imaging exams. Although pre-hospital screening ultrasound is not intended for definitive diagnoses, the early detection of intrahepatic biliary tract dilatation through screening sonography played a significant role in the clinical referral of patients, with a sensitivity of 94% and specificity of 75%. Full article

Introduction: Airway management remains a high-risk intervention in a subset of patients, with traditional predictors like the Mallampati score demonstrating poor sensitivity and specificity. Point-of-care ultrasound (POCUS) has emerged as a transformative tool, offering real-time, objective assessment of airway anatomy to improve safety and outcomes. Methods: A narrative approach was conducted to evaluate the literature on airway ultrasound, incorporating clinical metrics and procedural applications. Results: Ultrasound has demonstrated utility in pre-intubation risk stratification using quantitative measures such as skin-to-epiglottis distance (>2.75 cm) and hyomental distance ratio (<1.2), which outperform traditional exams, especially in obese patients. Procedural uses include endotracheal tube confirmation with 98.9% sensitivity and enhanced success rates in emergent cricothyroidotomy—from 50% to nearly 100%—in patients with difficult anatomy. Dynamic applications like assessing laryngeal edema via parapharyngeal thickness offer advantages over traditional cuff leak tests. Technical considerations such as optimal probe selection, patient positioning, and interpretation of key anatomical landmarks are also discussed. Conclusions: Airway ultrasound is poised to become a standard tool in perioperative and critical care settings. The review concludes by emphasizing POCUS as an indispensable adjunct for modern airway management. Full article

Background: Although the value of point-of-care ultrasound (PoCUS) is well-established for specific diseases and in the hands of trained users, its broader impact on overall ED efficiency is not yet fully known. This study aims to evaluate the association of early PoCUS, performed within 1 h of presentation, with ED patient flow, healthcare resource utilization, and quality of care in adults with non-traumatic abdominal pain. Method: This retrospective cohort study included 44,863 adult patients (≥18 years) presenting with non-traumatic abdominal pain from January 2021 to December 2023. Patients were grouped into PoCUS and no-PoCUS categories, with a subgroup analysis for those receiving PoCUS within 1 h, to evaluate ED LOS, and costs for different ED dispositions. Outcomes measured included hospital LOS, costs, mortality, and ICU admission. Results: The mean age of the subjects was 44.4 ± 17.9 years, and 61.2% were female. PoCUS was performed in 39.7% of cases, with 69.6% of these conducted within one hour. Additionally, 30.5% underwent CT. The PoCUS group had a significantly shorter ED LOS compared to the no-PoCUS group among patients admitted to general wards (p < 0.001), but not in outpatient dispositions (p = 0.282) or ICU admissions (p = 0.081). Subgroup analysis of patients receiving PoCUS within 1 h showed a significantly shorter LOS for both outpatient dispositions (p < 0.001) and general ward admissions (p < 0.001), with no effect on ICU admissions (p = 0.869). The presence or absence of CT did not alter these findings. Multivariable analysis indicated that patients who received PoCUS within one hour alone at index visit and admitted after an unscheduled return visit had lower initial ED costs (−9436.1 TWD, p < 0.001) and shorter ED LOS (−11.59 min, p < 0.001) than patients admitted directly at the index visit, with no significant increase in total resource utilization or adverse outcomes after return visits. Conclusions: PoCUS, especially when performed within one hour, was associated with reduced ED LOS and healthcare resource utilization for both outpatient dispositions and inpatient admissions without compromising patient safety or quality of care. Full article

Intraventricular hemorrhage (IVH) is a common complication encountered in extremely-low-birth-weight (ELBW) and very-low-birth-weight (VLBW) premature babies. The neurologic outcome of these patients is influenced by the magnitude of the hemorrhagic process that damages the involved anatomic structures but also by the impaired circulation of cerebrospinal fluid (CSF) through the ventricular system, leading to posthemorrhagic ventriculomegaly (PHVM). Cranial ultrasound (CUS) performed by neonatologists (point-of-care ultrasound—POCUS) facilitates the early diagnosis of IVH and PHVM and can objectively quantify structural alterations. Our aim was to identify the best sonographic criteria to follow-up with ventricular dilatation and predict the need for neurosurgery and neurologic deterioration. We performed a literature review in search of the most relevant ventricular measurements considered by neurosurgeons, neonatologists, and pediatric neurologists to reflect the risk of white matter injury and high intracranial pressure (HIP), thus anticipating neurologic developmental impairment (NDI). The tridimensional picture of ventricular dilatation is best captured if more than one index (ventricular index and anterior horn width) or ratio (Evans ratio, fronto-occipital horn ratio, and fronto-temporal horn ratio) is used. Conclusions: If performed using the correct protocol, serially and comprehensively, CUS is an indispensable tool for the diagnosis and follow-up of neurologic complications of preterm babies, and it can make a difference in guiding adequate intervention and improving long-term developmental outcomes. Full article

Hemodynamic assessment is critical in emergency and critical care for preventing, diagnosing, and managing shock states that significantly affect patient outcomes. Point-of-care ultrasound (POCUS) has become an invaluable, non-invasive, real-time, and reproducible tool for bedside decision-making. Advancements such as Doppler imaging, advanced critical care ultrasonography, and transesophageal echocardiography (TEE) have expanded its utility, enabling rapid and repeatable evaluations, especially in complex mixed shock presentations. This review explores the role of POCUS in hemodynamic monitoring, emphasizing its ability to assess cardiac output, filling pressures, and vascular congestion, facilitating shock classification and guiding fluid management. We highlight an extensive array of POCUS techniques for evaluating right and left cardiac function and review existing literature on their advantages, limitations, and appropriate clinical applications. Beyond assessing volume status, this review discusses the role of POCUS in predicting fluid responsiveness and supporting more individualized, precise management strategies. Ultimately, while POCUS is a powerful tool for rapid, comprehensive hemodynamic assessment in acute settings, its limitations must be acknowledged and thoughtfully integrated into clinical decision-making. Full article

Background and Objectives: The introduction of portable ultrasound devices has transformed clinical practice in emergency medicine. Diagnostic accuracy and patient safety have been enhanced by point-of-care ultrasonography (POCUS), which has become a fundamental diagnostic and procedural tool. In addition to the standard clinical evaluation, POCUS provides quick patient assessments, allowing for the exclusion of life-threatening conditions and prognostication in different critical situations. Tissue Doppler imaging (TDI), as an advanced echocardiographic technique, offers additional quantitative data by measuring myocardial velocities, thereby improving the evaluation of systolic and diastolic ventricular function. The purpose of this review is to highlight the potential use of TDI in multiple acute and critical conditions. Materials and Methods: We conducted a narrative review of the main application topics for TDI. Results: TDI is an essential diagnostic and prognostic tool for acute coronary syndromes, assessing systolic or diastolic dysfunction, and etiological diagnosis of acute heart failure. It helps differentiate cardiogenic pulmonary edema from acute respiratory distress syndrome and identifies right ventricular systolic dysfunction in acute pulmonary embolism. TDI also facilitates distinctions between hypertension emergencies and urgencies and contributes to the stratification of atrial fibrillation reoccurrence risk. Furthermore, it aids in the differentiation of constrictive pericarditis from other restrictive cardiomyopathy patterns. In intensive care settings, TDI is particularly valuable during mechanical ventilation weaning, where elevated E/E’ values serve as a predictor of weaning failure. Due to its accessibility, rapid execution, and high reproducibility, it is suitable for longitudinal monitoring. Conclusions: TDI enhances the diagnostic precision, guides therapeutic strategies, and provides critical prognostic insights across a wide range of time-sensitive clinical scenarios, solidifying its role as an indispensable tool in modern emergency and critical care practice. Full article

Background/Objectives: Acute obstructions of the upper respiratory tract are emergencies that may require a cricothyrotomy as ultima ratio. For this, precise identification of the conic ligament is essential. Point-of-care ultrasound (POCUS) offers a reliable tool for anatomical localization in challenging cases and could be used by a range of emergency medicine workers. This prospective, controlled observational study assesses the development of competencies of paramedics (PMs) in point-of-care ultrasound (POCUS) assisted identification of the conic ligament after structured training, and compares their competence level to emergency physicians (EPs). Methods: PMs and a control group of EPs received an identical structured training program as part of an ultrasound course. It included a 10-min theoretical introduction, a 10-min video, and a 45-min practical session with ultrasound devices. Questionnaires and a practical test assessed both group’s previous experiences, satisfaction with training, and the development of subjective and objective competencies before (T₁) and after (T₂) the training. Results: A total of 120 participants (N = 92 PMs and N = 28 EPs) participated. A minority had previously performed a cricothyrotomy even in training settings (PMs 17%; EPs 11%), and none had identified the conic ligament using POCUS. The study group’s subjective and objective competencies increased significantly (p < 0.001). At T2, the study group demonstrated comparable subjective (p = 0.22) and objective (p = 0.81) competencies to those of the control group. The study group needed significantly (p < 0.01) less time to perform the DOPS. While both groups were satisfied with the study material (PMs 2.2 ± 1.2 vs. Eps 1.6 ± 1.0; p = 0.02) and the training (PMs 1.8 ± 1.0 vs. EPs 1.4 ± 0.7, p = 0.03), the study group rated both significantly better. Conclusions: After structured training, paramedics successfully identified the conic ligament using POCUS comparably to emergency physicians. Integrating POCUS into paramedic training may improve prehospital airway management and enhance patient safety. Further studies should investigate long-term skill retention and real-life application. Full article

The hospital-at-home (HaH) model offers hospital-level care within patients’ homes and has proven effective for managing conditions such as pneumonia. The point-of-care ultrasonography (PoCUS) is a key diagnostic tool in this model, especially when traditional imaging modalities are unavailable. This review explores how PoCUS can be optimized to manage pneumonia in HaH settings, focusing on its diagnostic accuracy in patients with comorbidities, differentiation from mimickers, and role in assessing disease severity. Pulmonary comorbidities, such as heart failure and interstitial lung disease (ILD), can complicate lung ultrasound (LUS) interpretation. In heart failure, combining lung, cardiac, and venous assessments (e.g., IVC collapsibility, VExUS score) improves diagnostic clarity. In ILD, distinguishing chronic changes from acute infections requires attention to B-line patterns and pleural abnormalities. PoCUS must differentiate pneumonia from conditions such as atelectasis, lung contusion, cryptogenic organizing pneumonia, eosinophilic pneumonia, and neoplastic lesions—many of which present with similar sonographic features. Serial LUS scoring provides useful information on pneumonia severity and disease progression. Studies, particularly during the COVID-19 pandemic, show correlations between worsening LUS scores and poor outcomes, including increased ventilator dependency and mortality. Furthermore, LUS scores correlate with inflammatory markers and gas exchange metrics, supporting their prognostic value. In conclusion, PoCUS in HaH care requires clinicians to integrate multi-organ ultrasound findings, clinical context, and serial monitoring to enhance diagnostic accuracy and patient outcomes. Mastery of LUS interpretation in complex scenarios is crucial to delivering personalized, high-quality care in the home setting. Full article

Background: Echocardiography is crucial to understanding cardiac function in the Intensive Care Unit (ICU), often by measuring the left ventricular ejection fraction (LVEF). Traditionally, measures of LVEF are completed as part of a comprehensive examination by an expert sonographer or cardiologist, but front-line practitioners increasingly perform focused point-of-care estimates of LVEF while managing life-threatening illness. The two main echocardiographic windows used to grossly estimate LVEF are parasternal and apical windows. Artificial intelligence (AI) algorithms have recently been developed to assist non-experts in obtaining and interpreting point-of-care ultrasound (POCUS) echo images. We tested the feasibility, accuracy and reliability of novice users estimating LVEF using POCUS-AI echo. Methods: A total of 30 novice users (most never holding an ultrasound probe before) received 2 h of instruction, then scanned ICU patients (10 patients, 80 scans) using the Exo Iris POCUS probe with AI guidance tool. They were permitted up to 5 min to attempt parasternal long axis (PLAX) and apical 4 chamber (A4C) views. AI-reported LVEF results from these scans were compared to gold-standard LVEF obtained by an expert echo sonographer. To further assess accuracy, this sonographer also scanned another 65 patients using Exo Iris POCUS-AI vs. conventional protocol. Results: Novices obtained images sufficient to estimate LVEF in 96% of patients in <5 min. Novices obtained PLAX views significantly faster than A4C (1.5 min vs. 2.3 min). Inter-rater reliability of LVEF estimation was very high (ICC 0.88–0.94) whether images were obtained by novices or experts. In n = 65 patients, POCUS-AI LVEF was highly specific for a decreased LVEF ≤ 40% (SP = 90% for PLAX) but only moderately sensitive (SN = 56–70%). Conclusions: Estimating cardiac LVEF from AI-enhanced POCUS is highly feasible even for novices in ICU settings, particularly using the PLAX view. POCUS-AI LVEF results were highly consistent whether performed by novice or expert. When AI detected a decreased LVEF, it was highly accurate, although a normal LVEF reported by POCUS-AI was not necessarily reassuring. This POCUS-AI tool could be clinically useful to rapidly confirm a suspected low LVEF in an ICU patient. Further improvements to sensitivity for low LVEF are needed. Full article