Doctors cast doubt on POCUS, warn data showing safety, clinical benefits ‘urgently’ needed
Point-of-care ultrasonography has become the affordable standard of care for many bedside procedures, but some clinicians are now questioning if the imaging technique is truly benefiting patients.
Providers with the Cleveland Clinic Foundation and Duke University called out POCUS in an opinion piece published Oct. 11 in JAMA Internal Medicine.
Many clinicians praise its convenience, the editorialists noted, particularly in limited-resource settings. It’s been shown to quickly narrow the list of differential diagnoses, assist physical exams, improve decision making and earn high patient satisfaction scores. But the authors say providers may be too quick to lavish praise.
“However, while endorsed by the American College of Physicians and the Society of Hospital Medicine, its use for diagnostic purposes is not as firmly grounded in evidence demonstrating net benefit on patient outcomes,” added Eden Bernstein, MD, with Cleveland Clinic Community Care and Tracy Y. Wang, MD, MHS, MSc, of Duke Clinical Research Institute.
For example, exams are often completed without formal documentation and images may not be readily available for quality assurance. Additionally, few studies have analyzed meaningful POCUS-related clinical outcomes, the pair added. One of the largest trials to do so failed to demonstrate the modality's benefits regarding a host of clinical outcomes.
So, what must be done to establish this bedside test as a reliable tool?
“We recommend making POCUS use more evidence-based by focusing research efforts on assessing the role of POCUS in patient treatment and clinical outcomes,” Bernstein and Wang argued.
For one, more data are needed to assess interclinician variabilities, downstream consequences and false-positive rates. Such information should be gathered via “rigorously” designed trials.
“Given the rapid evolution of this bedside technology and increasing interest in use, data to reassure us that POCUS is consistently deployed and produces meaningful clinical benefit are urgently needed,” the authors warned. “Additional data on safety outcomes, such as misdiagnosis and burden of downstream testing as a result of POCUS use, will complement benefit-risk assessments and cost-effectiveness analyses guiding future use.”
Read the full opinion piece here.
Matt joined Chicago’s TriMed team in 2018 covering all areas of health imaging after two years reporting on the hospital field. He holds a bachelor’s in English from UIC, and enjoys a good cup of coffee and an interesting documentary.