Point-of-care ultrasound for evaluating acute dyspnoea in emergency departments: Systematic review and meta-analysis

Table 1 Summary of studies comparing point of care ultrasound to standard imaging modalities

Ref.	Year of publication	Country of study	Study design and setting	Number of patients enrolled	Summary of the patient population	Intervention used	Comparison used	Definition of outcome measured	Number of patients who achieved the outcome in the intervention group	Number of patients who achieved the outcome in the comparison group
Özkan et al[25]	2015	Turkey	RCT	63	Patients presenting with dyspnoea in the emergency department	POCUS performed by emergency medicine specialists	Traditional stethoscope examination	Diagnostic performance in identifying causes of dyspnoea	First diagnosis is compatible with final diagnosis: 18	First diagnosis is compatible with final diagnosis: 19
Pontis et al[26]	2018	France	RCT	107	Acute dyspnoeic patients	Lung ultrasound	Clinical data without LUS	Diagnostic accuracy and the number of uncertain diagnoses when using LUS compared to clinical data	Number of uncertain diagnoses mean: 2.2 ± 1.7	Number of uncertain diagnoses mean: 2.9 ± 1.8
Zare et al[2]	2022	Iran	RCT	103	Patients with undifferentiated acute dyspnoea	POCUS performed by emergency specialists	Standard diagnostic approach without POCUS	Impact of POCUS on early patient disposition decisions in the ED	Mean time of diagnosis 42.61 minutes	Mean time of diagnosis 79.33 minutes
Baker et al[27]	2020	Australia	RCT	442	Patients aged over 60 years presenting with dyspnoea	POCUS performed by non-expert clinicians after brief training	Standard diagnostic assessment without the use of LUS	(1) Accurate diagnosis of pulmonary oedem; and (2) Length of ED stay	Correct diagnosis 60 out of 68	Correct diagnosis 53 out of 64
Beyer et al[7]	2021	United States	Multicentre, prospective, cohort study	156	Patients with undifferentiated dyspnoea	POCUS by trained ED	POCUS performed by USS team	Effectiveness of POCUS in narrowing diagnostic uncertainty in dyspnoeic patient	Most likely diagnosis changed in 40%	Diagnosis changed in 32%
Baid et al[3]	2022	India	Prospective observational study	237	Patients presenting with acute dyspnoea	POCUS performed by emergency physicians	Final composite diagnoses made by two emergency medicine consultants	To determine the diagnostic accuracy of POCUS in various causes of acute onset dyspnoea	Median time for diagnosis 16 minutes	Median time for diagnosis 170 minutes
Pivett et al[28]	2015	Italy	Multicenter, prospective cohort study	1005	Patients presenting to the ED with acute dyspnoea	LUS	Initial assessment, CXR and BNP	Diagnostic accuracy of LUS compared to CXR	Sensitivity 97%; specificity 97.4%	CXR: Sensitivity 69.5%; specificity 82.1%; BNP sensitivity 75% specificity 61.7%
Nakao et al[29]	2021	Canada	Prospective diagnostic accuracy study	324	Patients with SOB and cough suspected to be COVID or COPD	POCUS	Patients not evaluated by POCUS	ED length of stay and time to treatment	Time to treatment 61 minutes	Time to treatment 92 minutes
Mantuan et al[30]	2016	United States	Prospective observational study	57	Patients presenting with acute dyspnoea	Triple scan (LUS, Echo and IVC)	Clinical assessment	Compare diagnostic accuracy before and after TS	Diagnostic accuracy 77%	Diagnostic accuracy 53%
Papanagnou et al[4]	2017	United States	Prospective observational study	115	Adult patients with undifferentiated dyspnoea	Bedside USS	Diagnosis before USS	(1) Post-ultrasound diagnoses matched final diagnoses; (2) Frequency ultrasound altered providers’ leading diagnoses; and (3) Change in physicians’ diagnostic confidence	Matched final diagnosis 63% of the time	Matched final diagnosis 69% of the time
Buhumaid et al[16]	2019	United States	Prospective observational study	128	Patients presenting with CP and SOB to ED	POCUS	CXR	(1) How use POCUS in ED differentials; and (2) Evaluate accuracy of POCUS vs CXR	POCUS sensitivity 89%. Specificity 74%	CXR sensitivity 38%. Specificity 96%
Núñez-Ramos et al[31]	2024	Colombia	Analytical cross-sectional study	209	Patients with dyspnoea, suspected ACS, HF, shock and/or HTN	POCUS	Final diagnosis	Evaluate initial POCUS diagnosis with the diagnosis on discharge	Diagnostic accuracy: HF 99, ACS 98, Shock 98
Pirozzi et al[6]	2014	Italy	Single center randomized prospective study	168	Patients presenting with undifferentiated dyspnoea	POCUS and routine laboratory	USS in 1 hour	Diagnostic accuracy by using POCUS	(1) Diagnostic concordance 0.94; and (2) Wrong initial diagnosis 5%	(1) Diagnostic concordance 0.22; and (2) Wrong initial diagnosis 50%
Martindale et al[32]	2013	United States	Prospective, blinded, observational study	20	Resident physicians in ED, IM and radiology	LUS	CXR	To evaluate the ability of residents to recognize pulmonary oedema on LUS	Sensitivity 99%. Specificity 61%	Sensitivity 97%. Specificity 32%
Sharma et al[1]	2025	India	Prospective cohort study	104	Patients presenting with acute shortness of breath	Bedside LUS, NT-pro BNP, and clinical parameters	Clinical assessment using modified Boston criteria and NT-pro BNP levels alone	Accuracy of LUS/Pro BNP in differentiating pulmonary from cardiac causes of SOB	LUS sensitivity of 100%, specificity of 62.3%	NT-pro BNP 100% sensitivity, 91.8% specificity 100%
Bitar et al[33]	2015	Kuwait	A prospective observational study	61	Patients presenting with symptoms and signs of pulmonary oedema	LUS and Echo	BNP levels	Diagnostic accuracy of LUS and Echo in pulmonary oedema	Sensitivity 92%. Specificity 90.9%	Sensitivity 97.9%. Specificity 71.4%
Zare et al[2]	2022	Iran	Prospective multicentre study	103	Patients with acute undifferentiated dyspnoea	Early POCUS in ED	Routine USS	Evaluate the role of bedside USS to identify the cause of undifferentiated dyspnoea and faster disposition in ED	Mean randomization-to-diagnosis time 4261 minutes	79.33 minutes
Umuhire et al[5]	2019	Rwanda	Prospective observational study	99	Patients presenting with dyspnoea	Multi-organ POCUS scans	Pre- and post-ultrasound clinical assessments	Changes in leading diagnosis and diagnostic accuracy	Leading diagnosis matched the final discharge diagnosis in 89% of cases	Leading diagnosis matched the final discharge diagnosis in 34.3% of cases
Sartini et al[34]	2017	Italy	Prospective study	236	Patients presenting with acute dyspnoea	LUS performed to diagnose acute HF	Diagnostic accuracy of LUS compared with CXR and NT-pro BNP levels	Accuracy of LUS, CXR, and NT-pro BNP in the early diagnosis of AHF	Sensitivity 57.73%. Specificity 87.97%	CXR: 74.49%, 86.26. BNP 97.59%, 27.56
Yahia et al[35]	2022	Egypt	Prospective observational study	47	Patients presenting with dyspnoea and symptoms suggestive of AHF	LUS	Plasma Pro BNP	Accuracy and usefulness of LUS in assessment	Sensitivity of 91.9%. Specificity of 100%	Sensitivity of 100%, specificity of 60%
Secko et al[36]	2022	United States	Prospective observational study	102	Patients with undifferentiated dyspnoea	Bedside LUS	Physical examination	Diagnostic accuracy of LUS vs physical examination	Accuracy is the same for CPD and asthma. LUS more accurate in pneumonia, pulmonary oedema and effusion	Accuracy is the same for CPD and asthma. LUS more accurate in pneumonia, pulmonary oedema and effusion
Pivetta et al[28]	2019	Italy	RCT	518	Patients with acute dyspnoea	Lung ultrasound was integrated with clinical assessment	CXR and BNP	Accuracy and utility of combining LUS/clinical assessment vs CXR/BNP	Diagnostic accuracy AUC 0.95	AUC 0.78
Arvig et al[37]	2023	Denmark	RCT	206	Patients presented with dyspnoea	POCUS within 1 hour of arrival plus two additional POCUS	A single POCUS within 1 hour of arrival	A reduction of dyspnoea measured on a verbal dyspnoea scale	The mean difference in VDS -1.09	The mean difference in VDS -1.66
Sorlini et al[38]	2021	Italy	Single retrospective study	384	Patients with symptoms and signs of respiratory infection	POCUS performed at the time of admission or shortly afterwards	CXR	Assess diagnostic accuracy of POCUS	Sensitivity 92% CXR 64.9%	Sensitivity 73.9%. Specificity 55.9%
Gibbons et al[39]	2021	United States	Prospective cohort study	110	Patients presenting with symptoms of COVID19	Portable LUS, CXR and CT (if abnormal)	CXR and CT	Compare test characteristics of LUS and CXR in COVID19	LUS sensitivity 97.6%. Specificity 33.3%	CXR sensitivity 96.9%. Specificity 44.4%
Bianchi et al[40]	2022	Italy	Prospective cohort study	360	Patients with symptoms suggestive of COVID-19	POCUS by emergency physician	CT and PCR	Analyse diagnostic power of POCUS for COVID19	Sensitivity 86%, specificity 70%, accuracy 77%	CXR (sensitivity 64.9%, specificity 88.5% and accuracy 79.6%) BNP (sensitivity 80%, specificity 69.7% and accuracy 75%)
Carlino et al[41]	2009	Italy	Prospective cohort study	100	Patients presenting with acute dyspnoea	Integrated ultrasound examination	CXR and BNP	To identify accuracy of an integrated ultrasound approach for diagnosis of acute heart failure	Sensitivity 100%, specificity 82% and accuracy 89%	CXR (sensitivity 64.9%, specificity 88.5% and accuracy 79.6%) BNP (sensitivity 80%, specificity 69.7% and accuracy 75%)
Sforza et al[42]	2017	Italy	Diagnostic accuracy study	68	Patients presenting with acute dyspnoea to ED	Multi-organ ultrasound using a pocket-sized ultrasound device	CXR	To test the usefulness and accuracy of multi-organ USS	Sensitivity 92.6, specificity 80.5% and accuracy 85.3%	CXR (sensitivity 75%, specificity 85.4% and accuracy 82%)
Wooten et al[43]	2019	United States	Prospective observational cohort study	99	Patients presenting with dyspnoea to ED	Bedside LUS	CXR	Assess accuracy of LUS and CXR in pulmonary oedema	Sensitivity 96%, specificity 90%	Sensitivity 65%. Specificity 95%

ACS: Acute coronary syndrome; ARC: Area under curve; BNP: Brain natriuretic peptide; CP: Chest pain; CPD: Chronic pulmonary disease; CXR: Chest X-ray; CT: Computed tomography; ED: Emergency department; HF: Heart failure; HTN: Hypertension; IM: Internal medicine; VDS: Verbal dyspnoea scale; IVC: Inferior vena cava; LUS: Lung ultrasound; POCUS: Point of care ultrasound; RCT: Randomised controlled trial; SOB: Shortness of breath; TS: Triple scan; USS: Ultrasound.

Table 2 Studies evaluating point of care ultrasound as a standalone diagnostic tool without comparison to other imaging modalities

Ref.	Year of publication	Country of study	Study design and setting	Number of patients enrolled	summary of the patient population	Intervention used	Comparison used	Definition of outcome measured	TP	FP	TN	FN
Özkan et al[25]	2014	Turkey	Prospective cohort study	96	Patients presented with dyspnoea	Bedside LUS	NA	Accuracy of bedside USS to diagnose accuracy of dyspnoea	41	2	45	4
Sorlini et al[38]	2020	Italy	Single retrospective study	384	Patients with symptoms and signs of respiratory infection	POCUS performed at the time of admission or shortly afterwards	NA	Assess diagnostic accuracy of POCUS	264	34	63	23
Markarian et al[54]	2020	France	Multicenter prospective observational cohort study	100	Patients with acute dyspnoea	LUS	NA	Accuracy of LUS score to detect respiratory support need
Sanjan et al[45]	2019	India	Prospective observational study	73	Patients diagnosed with ARDS according to Berlin criteria	POCUS	No comparison group: The study focused on analysing lung ultrasound findings within the cohort	The utility of POCUS in the initial assessment of ARDS
Gibbons et al[39]	2021	United States	Prospective cohort study	110	patients presenting with symptoms of COVID-19	Portable LUS, CXR and CT (if abnormal)	NA	Compare test characteristics of LUS and CXR in COVID-19	79	19	10	2
Bianchi et al[40]	2021	Italy	Prospective cohort study	360	Patients with symptoms suggestive of COVID-19	POCUS by emergency physicians	NA	Analyse diagnostic power of POCUS for COVID-19	120	64	156	20
Msolli et al[14]	2021	Tunisia	Prospective observational study	700	Patients admitted for acute dyspnoea as chief complaint	LUS performed by a pair of ED residents	NA	To assess the accuracy and reproducibility of USS in CHF	325	82	247	82
Vauthier et al[46]	2021	France	Prospective diagnostic accuracy study	103	Patients presenting to the ED with acute dyspnoea	POCUS algorithm (LUS and Echo)	No comparison group	Evaluate diagnostic performance of pocus in patients with acute SOB	40	4	57	2
Altuğ et al[47]	2024	Turkey	A single-center prospective study	100	Patients with ARDS as per Berlin criteria	LUS score to investigate prognosis	No comparison group	Prognostic value of the LUS Score in ARDS patients	48	4	44	4
Patel et al[13]	2018	Pakistan	observational study	50	patients with ARDS	Bedside LUS in emergency protocol	No control group	Determine the accuracy of BLUE protocol in ARDS	45	6	194	5
Glöckne et al[48]	2020	Germany	Prospective mono-center study	102	Adult patients presenting with undifferentiated acute dyspnoea	POCUS in diagnosing AHF and monitoring the therapeutic success	Not stated	Evaluates the accuracy of POCUS in diagnosing AHF and monitoring the therapeutic success	27	1	39	22
Cibinel et al[49]	2011	Italy	Prospective study	56	Patients presented with acute dyspnoea	PLUS	Not stated	Evaluate diagnostic accuracy of PLUS to differentiate cardiogenic and non-cardiogenic causes of acute dyspnoea	25	5	24	2
Carlino et al[41]	2018	Italy	Prospective observational study	100	Patients presenting with acute dyspnoea	Integrated ultrasound examination	Not stated	To identify accuracy of an integrated ultrasound approach for diagnosis of acute heart failure	37	6	55	2
Liu et al[50]	2016	China	A prospective, single-blind trial	98 (27 with pneumonia HF)	Patients with acute dyspnoea in the ED	LUS and TTE were performed within 30 minutes	Not stated	Identify cardiogenic from infection cause of acute SOB	26	1	49	22
Ahn et al[51]	2017	South Korea	Single-center prospective observational study	308	Patients with dyspnoea, CP and symptomatic hypotension	Implementation of the SEARCH 8Es POCUS protocol	NA	POCUS ability to narrow differential diagnoses and increase physicians’ diagnostic confidence in patients with SOB, CP and hypotension	281	2	306	27
House et al[52]	2020	Nepal	Prospective cross-sectional study	280	Patients presenting with dyspnoea to the ED	LUS with pre and post scan diagnosis	NA	Changes in diagnosis and management following LUS	110	45	57	68
Farahmand et al[53]	2020	Iran	Diagnostic accuracy study	120	Patients were referred to ED with acute dyspnoea	Heart, lung and IVC USS	NA	Accuracy of USS to diagnose decompensated HF	88	89	31	32
Sforza et al[42]	2017	Italy	Diagnostic accuracy study	68	Patients presenting with acute dyspnoea to ED	Multi-organ ultrasound using a pocket-sized ultrasound device	NA	To test the usefulness and accuracy of multi-organ USS	25	8	33	2
Markarian et al[44]	2019	France	Observational single-centre study	137	Patients over age 64 admitted to the ED for acute dyspnoea with hypoxia	Early LUS by ED doctors followed by usual care	NA	Accuracy of LUS to evaluate severity of acute dyspnoea in elderly patients	40	1	93	3
Öhman et al[55]	2019	Finland	Prospective diagnostic study	100	Patients with undifferentiated dyspnoea	Cardiothoracic and LUS	NA	Accuracy of cardiothoracic and LUS in diagnosing HF	50	2	48	0
Wooten et al[43]	2019	United States	prospective observational cohort study	99	Patients presenting with dyspnoea to ED	Bedside LUS and CXR	NA	Assess accuracy of LUS and CXR in pulmonary oedema	31	7	60	1

AHF: Acute heart failure; ARDS: Acute respiratory distress syndrome; CHF: Congestive heart failure; CP: Chest pain; COVID-19: Coronavirus disease 2019; CXR: Chest X-ray; ED: Emergency department; HF: Heart failure; IVC: Inferior vena cava; IUE: Integrated ultrasound examination; LUS: Lung ultrasound; NA: Not available; POCUS: Point of care ultrasound; SOB: Shortness of breath; TTE: Transthoracic echocardiography; TS: Triple scan; USS: Ultrasound.