Are point-of-care ultrasound (POCUS) automatic tools accurate for echocardiographic interpretation?

From the Guidelines

Echocardiographic POCUS automatic tools are not entirely accurate for interpretation and should be used with caution, as an adjunct to clinician expertise, due to their limitations in image quality and potential for false positives or missed subtle abnormalities. The accuracy of these tools varies depending on the specific parameter being measured, image quality, and the particular software being used, with accuracy rates typically ranging from 80-90% compared to expert interpretation 1.

Key Considerations

• Automated tools perform best in patients with good acoustic windows and may be less reliable in technically difficult studies such as those in obese patients, patients with lung disease, or those on mechanical ventilation 1.
• The primary advantage of these tools is their ability to provide rapid, standardized measurements that can assist less experienced operators in making timely clinical decisions, particularly in emergency settings 1.
• However, clinicians should maintain appropriate training in image acquisition and interpretation, as automated tools may miss subtle abnormalities or generate false positives in suboptimal imaging conditions 1.
• Regular calibration and validation of these tools against expert interpretation is necessary to ensure ongoing accuracy in clinical practice 1.

Limitations of POCUS Automatic Tools

• Image quality is generally inferior when compared with high-end systems, and this might be particularly important in difficult patients, resulting in technically suboptimal studies, leading to less reliable findings 1.
• Pocket-sized imaging devices have marked limitations, including the inability to perform a complete echocardiogram, and their use should be limited to qualitative evaluation of ventricular and valvular function, pericardial and pleural effusion, or extravascular lung water 1.

From the Research

Echocardiographic POCUS Automatic Tools Accuracy

• The accuracy of echocardiographic POCUS automatic tools for interpretation has been studied in various research papers 2, 3, 4, 5, 6.
• A study published in the Journal of clinical medicine in 2023 found that automatic real-time measuring tools can make accurate measurements fast and simple, and dramatically increase examination reliability while saving the operator much time and effort 2.
• The study compared three automatic tools integrated into the Venue™ device by GE with the gold standard, an examination by a POCUS expert, and found good agreement between the POCUS expert and the auto tool for high-quality views 2.
• Another study published in Echocardiography in 2023 found that goal-directed point of care ultrasound (POCUS) performed by a consulting cardiologist during the initial cardiology consult can detect more abnormal echo findings, result in more medication adjustments, and less referral for noninvasive stress testing 3.
• The use of POCUS in cardiac arrest has also been studied, with a review published in The American journal of emergency medicine in 2018 finding that POCUS provides a diagnostic and prognostic tool in the emergency department, which may improve accuracy in clinical decision-making 4.
• A comprehensive review published in the Journal of clinical medicine in 2024 described the current and potential application of echocardiography and POCUS for pre-ECMO assessment and patient selection, cannulation guidance, diagnosis of ECMO complications, and assessment of ECMO weaning appropriateness 5.
• A study published in the Journal of cardiothoracic and vascular anesthesia in 2021 found that point-of-care echocardiography can be a useful tool for assessing complex arrhythmias in pediatric patients with congenital heart diseases, mainly when an epicardial register or electrophysiology study is not available 6.

Key Findings

• Automatic real-time measuring tools can make accurate measurements fast and simple, and dramatically increase examination reliability 2.
• POCUS can detect more abnormal echo findings, result in more medication adjustments, and less referral for noninvasive stress testing 3.
• POCUS provides a diagnostic and prognostic tool in the emergency department, which may improve accuracy in clinical decision-making 4.
• Echocardiography and POCUS play a critical role in the selection and management of ECMO patients 5.
• Point-of-care echocardiography can be a useful tool for assessing complex arrhythmias in pediatric patients with congenital heart diseases 6.