Con: Limitations of POCUS Examination: Be Aware of Overdiagnosis and Undertreatment

Abstract

ULTRASOUND IS A REVOLUTIONARY, noninvasive imaging tool that, when used and interpreted by trained personnel in the proper clinical situation, can provide correct diagnosis and treatment. Point-of-care ultrasound (POCUS) is defined as a handheld, mobile, broadly applied ultrasound machine capable of performing limited studies at bedside to provide answers to focused, closed-ended, binary questions. 1 Baribeau Y Sharkey A Chaudhary O et al. Handheld point-of-care ultrasound probes: The New generation of POCUS. J Cardiothorac Vasc Anesth. 2020; 34: 3139-3145 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar , 2 Reisinger NC Koratala A. Incorporating training in POCUS in nephrology fellowship curriculum. Clin J Am Soc Nephrol. 2022; 17: 1442-1445 Crossref PubMed Scopus (0) Google Scholar Over the last 15 years, the medical literature has demonstrated the importance of this tool in medical practice, 3 Miller DL Abo A Abramowicz JS et al. Diagnostic ultrasound safety review for point-of-care ultrasound practitioners. J Ultrasound Med. 2020; 39: 1069-1084 Crossref PubMed Scopus (17) Google Scholar with applications including delineation of airway structures, lung pathology, cardiac structure and function, gastric volume and content, guided vascular procedures, and emergent focused assessment with sonography for trauma examination. 4 Kalagara H Coker B Gersterin NS et al. Point-of-care ultrasound (POCUS) for the cardiothoracic anesthesiologist. J Cardiothorac Vasc Anesth. 2022; 36: 1132-1147 Abstract Full Text Full Text PDF PubMed Scopus (4) Google Scholar However, this readily accessible tool cannot completely replace patient history, physical examination, clinical judgment, and other formal imaging modalities read by a specialist for the diagnosis, monitoring, and treatment of patient clinical status. There is a concern for overdiagnosis and undertreatment of various clinical pathologies using POCUS, and future direction is needed to optimize this diagnostic tool and prevent overdiagnosis and undertreatment.