Use of point-of-care ultrasound in evaluating unstable patients outside intensive care units

Introduction: Point of care ultrasound (POCUS) has become an integral asset in intensive care units (ICU). However, there is limited literature on the value of POCUS in evaluating deteriorating patients outside ICU. In this study, we sought to investigate the use and impact of POCUS by ICU triage teams in hospitals outside of the ICU. Methods: For consults and rapid responses, ICU fellows were provided a portable ultrasound to use as part of their patient evaluations. Fellows were asked to fill out a survey regarding how ultrasound was used and its impact on patient management. Free text data such as reason for ultrasound use, views obtained, clinical impressions before and after ultrasound as well as how clinical decisions changed were recorded. These data were transcribed and categorized electronically, and then analyzed via Stata. Results: 51 total resuscitations were documented. The most common reason for ICU triage team evaluation was hypotension (53%). The most common clinical focus for ultrasound usage was volume status assessment (35%), followed by cardiac assessment (31%) and then pulmonary embolism evaluation (14%). Most common ultrasound views obtained were parasternal long (82%), followed by apical 4 chamber (76%) and subcostal views (75%). 79% of pre-ultrasound clinical impressions were confirmed by ultrasound use. However, when assessing for pulmonary embolisms, 40% of clinical impressions changed after using ultrasound. 37% of encounters had a significant clinical action taken based on ultrasound findings (fluid resuscitation, vasopressor initiation, etc), which increased to 50% when specifically evaluating cardiac assessment and volume status. Conclusions: Ultrasound is a valuable tool in patient evaluation on non-ICU wards especially in confirming clinical impressions and guiding therapeutic actions. Some limitations of this study include reporting bias and incomplete capture of all ultrasound usage on non-ICU wards. Next steps will include further analysis on specific presenting complaints (i.e mental status change, hypotension, dyspnea) and outcomes based on ultrasound usage outside the ICU.