POCUS OUTCOMES AND SAFETY: A ‘NON-COCHRANY’ LITERATURE REVIEW
by Justin Bowra and Alan Giles
Part of ‘Tackling the tough topics’: The POCUS Debate NSW - 9 November 2018
The question we asked: What does the literature say about the actual efficacy and safety of POCUS? (IE actual real-world patient outcomes, rather than surrogate markers such as diagnostic accuracy)
Methods: we asked a bunch of POCUS nerds from around the world to send us copies of any literature they had on the subject. We supplemented this by looking up papers that caught our eye, but if it cost actual money to download the articles we only downloaded the abstracts.
Thanks to: Adrian Goudie and Paul Atkinson in particular for sending many of these papers, and also thanks to Frank Norman, Kylie Baker and Bob Jarman for their sage advice.
The summary (for those with short attention spans)
If used carefully by those who are properly trained, POCUS has been demonstrated to improve outcomes. (e.g. in BAT, penetrating cardiac injury, arrested patients)
If used carelessly by idiots or those without proper training, POCUS has been shown to be useless (e.g. in stable BAT, and in shocked patients) or even harmful.
Or to put it another way: ‘POCUS doesn’t kill people; doctors do!’
Now for a little more detail…
FAST in blunt abdo trauma:
POCUS for undifferentiated shock:
Basic cardiac (2D look) in cardiac arrest:
POCUS in respiratory disease
Below are quotes from [Crager and Hoffman editorial. But it makes sense physiologically. Annals EM 2018 .pdf
The last word: (this is a quote from Rory Spiegel, commenting on Laursen’s respiratory POCUS study, in ‘‘ED Hocus POCUS ... or Just a Hoax?’ - https://www.emlitofnote.com/?p=298 )
I’m sure we all have experienced firsthand the utility of bedside US and this is by no means a call to abandon our probes, but rather an acknowledgement of the possibility of subtle harms. We must keep in mind, all testing comes at a price no matter how non-invasive and radiation-free it appears. The cost in this case is information and how we choose to act on it. This would certainly not be the first time increased access to medical technology has lead to such unintended consequences.
To quote Dr Russell McLaughlin, Belfast POCUS tragic: ‘A fool with a stethoscope will be a fool with an ultrasound.’
Ultrasound will not make you smarter, or make you a better doctor or a nicer person.
Alan Giles & Justin Bowra
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