POCUS influences clinical management – part 394.

Nixon G, Blattner K, Finnie W, Lawrenson R, Kerse N. Use of point‐of‐care ultrasound for the assessment of intravascular volume in five rural New Zealand hospitals. Can J Rural Med 2019;24:109‐14.

Another of Garry’s papers on POCUS, again showing it alters clinical decisions, this time for assessing intravascular volume.

Abstract

Introduction: Measuring the diameter of the inferior vena cava (IVC) or the height of the jugular venous pressure (JVP) with point‐of‐care ultrasound (POCUS) is a practical alternative method for estimating a patient’s intravascular volume in the rural setting. This study aims to determine whether or not POCUS of the IVC or JVP generates additional useful clinical information over and above routine physical examination in this context.

Methods: Twenty generalist physicians, working in five New Zealand rural hospitals, recorded their estimation of a patient’s intravascular volume based on physical examination and then again after performing POCUS of the IVC or JVP, using a visual scale from 1 to 11.

Results: Data were available for 150 assessments. There was an only moderate agreement between the pre‐ and post‐test findings (Spearman’s correlation coefficient = 0.46). In 28% (42/150) of cases, the difference was four or more points on the scale, and therefore, had the potential to be clinically significant.

Conclusion: In the rural context, POCUS provides new information that frequently alters the clinician’s estimation of a patient’s intravascular volume.