COMPARATIVE ANALYSIS OF POINT-OF-CARE ULTRASOUND AND CONVENTIONAL CLINICAL ASSESSMENT FOR VOLUME STATUS EVALUATION IN NEWLY ADMITTED HOSPITAL PATIENTS

Abstract

Background: Accurate volume status assessment is essential for managing newly admitted hospital patients. However conventional clinical methods have known limitations. Point-of-care ultrasound (POCUS) offers a rapid bedside alternative. This study compares the diagnostic performance of POCUS using inferior vena cava (IVC) assessment against standard clinical evaluation.

Methods: We conducted a prospective comparative study at the National Heart Institute with 150 newly admitted adults. Each patient underwent both a POCUS IVC exam and a conventional clinical assessment performed by separate blinded doctors. The reference standard was hemodynamic response to passive leg raise or fluid bolus.

Results: POCUS achieved a sensitivity of 81.2% and specificity of 84.6% for predicting fluid responsiveness using an IVC collapsibility index cutoff of 44%. Conventional clinical assessment gave a sensitivity of only 52.4% and specificity of 58.7%. Inter-observer agreement was excellent for POCUS (ICC 0.91) but poor for clinical exam (kappa 0.42). POCUS also took less time (4.2 vs 8.5 minutes) and changed management decisions in 35% of cases.

Conclusions: POCUS guided IVC assessment is significantly more accurate reliable and efficient than conventional clinical evaluation for volume status in newly admitted hospital patients. Routine integration of POCUS into admission protocols is recommended. [1]