Integrating Point-of-Care Ultrasound (POCUS) in Emergency Medicine: Enhancing Diagnostic Accuracy in Critical Care Settings

This prospective observational study evaluated the impact of systematic Point-of-Care Ultrasound (POCUS) integration on diagnostic accuracy, time-to-diagnosis, and clinical decision-making in a high-volume urban Emergency Department (ED). Over 12 months, 1,528 critically ill patients presenting with undifferentiated shock, respiratory failure, trauma, or cardiac arrest underwent structured POCUS examinations (eFAST, RUSH, FATE, Lung Ultrasound) by credentialed emergency physicians alongside standard care. Results demonstrated that POCUS significantly increased initial diagnostic accuracy compared to standard assessment alone (89.4% vs. 72.1%, p<0.001) and reduced median time-to-provisional diagnosis (14.3 min vs. 42.7 min, p<0.001). POCUS directly changed management in 38.6% of cases (e.g., fluid resuscitation strategy, thrombolysis, pericardiocentesis) and reduced CT utilization by 22.3% (p=0.004). Diagnostic sensitivity for pneumothorax reached 98.2% (vs. CXR 56.8%), and for pericardial effusion, 100% (vs. clinical exam 42.9%). Key limitations included operator skill dependence and limited utility for retroperitoneal evaluation. Findings support POCUS as a transformative tool enhancing diagnostic precision and accelerating life-saving interventions in critical care emergencies.