Point of care ultrasound (POCUS) applications in the ambulatory internal medicine setting: A scoping review.

Abstract

Point of care ultrasound (POCUS) is an increasingly recognized tool in internal medicine, with evidence supporting its use largely derived in the inpatient setting. We endeavored to provide an overview of outpatient POCUS applications that could be relevant to the practice of internal medicine. A scoping review was conducted using the JBI Evidence Synthesis framework. Studies of adults who received a POCUS assessment during an outpatient clinic encounter for an indication that was within the scope of practice of an internist were included. Data was extracted on POCUS intervention characteristics, POCUS applications, as well as outcomes such as validation, feasibility, prognostic value, clinical integration, resource utilization, and effect on medical management. A total of 100 studies were included in the final analysis. Most POCUS scans were conducted by cardiologists (n = 21) and family physicians (n = 31). The primary POCUS applications identified were lung (n = 30), cardiac (n = 29), vascular (n = 10), and musculoskeletal (n = 9). Screening applications for cardiac and vascular arterial disease were also uncovered (n = 16). POCUS was found to have prognostic value (n = 16/21, 76.2 %) and be feasible (n = 40/40, 100.0 %) in studies of various outpatient settings. Just over half of the studies reported POCUS interventions that were integrated into clinical care (n = 56), with many of these studies reporting that POCUS was associated with changes in medical management (n = 35/36, 97.2 %) and reduced resource utilization (n = 18/19, 94.7 %). POCUS use in the outpatient internal medicine setting is a promising modality to aid in the screening, early diagnosis, and prognostication of various pathologies.