Abstract

Acute dyspnea is a prevalent complaint in the emergency department (ED), presenting a diagnostic challenge due to its extensive differential diagnosis and the necessity for immediate evaluation. Conventional diagnostic methods can delay treatment, while point-of-care ultrasound (PoCUS) offers a rapid, bedside diagnostic alternative. This study aimed to evaluate the effect of PoCUS on clinical outcomes, including time to diagnosis, length of stay (LOS), diagnostic accuracy, and other clinical parameters in patients presenting with acute dyspnea to the ED. Using PubMed, Google Scholar, Web of Science, and the Cochrane Central Register of Controlled Trials database, a thorough literature search was conducted in September 2024. The randomized controlled trials (RCTs) published in the English language on PoCUS in patients with acute dyspnea arriving to ED or Intensive Care Unit were included. Two reviewers independently screened titles and abstracts using Rayyan. Full texts were assessed by another pair of reviewers. Four researchers independently performed data extraction. Study quality was evaluated using the Cochrane risk-of-bias tool. Meta-analysis was performed using STATA with a random-effects model; heterogeneity was assessed via the I2 statistic. Ten RCTs involving 2,710 patients were included. PoCUS significantly reduced time to diagnosis compared to conventional methods in most included studies. A meta-analysis found a statistically significant drop in hospital LOS (mean difference: -1.66 days; 95% CI: -2.93 to -0.39; p = 0.01). The PoCUS group had significantly greater diagnostic accuracy (pooled OR: 2.49; 95% CI [1.49, 4.14]). Though impacts on outcomes like death and LOS vary, PoCUS improves diagnostic accuracy and accelerates diagnosis in acute dyspnea.

Key words: Point-of-care ultrasound, acute dyspnea, diagnostic accuracy, length of stay, systematic review, meta-analysis