Point‑of‑Care Ultrasound for the diagnosis of acute dyspnea in adults

a systematic review

Abstract

Introduction: Acute dyspnea is a frequent cause of emergency care, associated with severe cardiopulmonary diseases. Traditional imaging methods present diagnostic and operational limitations. In this context, point-of-care ultrasonography (POCUS) emerges as a rapid, safe tool performed at the bedside. Protocols such as BLUE and FATE have demonstrated usefulness in cardiopulmonary assessment and in guiding therapeutic management in patients with acute dyspnea. Objectives: To evaluate the effectiveness of point-of-care ultrasonography (POCUS) in the diagnosis of acute dyspnea in adults, comparing it with conventional imaging methods and assessing its impact on clinically relevant outcomes. Methods: A systematic review was conducted in accordance with PRISMA guidelines, with searches performed in PubMed, Google Scholar, and open-access repositories up to January 2026. Randomized controlled trials, observational studies, and meta-analyses evaluating the use of POCUS in adults (≥18 years) with acute dyspnea in emergency or intensive care settings were included. Outcomes of interest comprised time to diagnosis, time to treatment initiation, sensitivity, specificity, adequacy of therapy, mortality, and length of hospital stay. Results: Thirteen studies totaling 5,393 participants met the eligibility criteria. The use of POCUS reduced time to diagnosis by approximately one hour and shortened time to treatment initiation by about 30 minutes, resulting in a mean reduction of 1.27 days in intensive care unit length of stay and a higher likelihood of appropriate therapy prescription¹. For the main causes of acute dyspnea, ultrasonography demonstrated higher sensitivity than chest radiography: for community-acquired pneumonia, sensitivity was 0.95 and specificity 0.90²; for cardiogenic pulmonary edema, sensitivity reached 94% with specificity of 92%³; and for traumatic pneumothorax, sensitivity was 83% and specificity 99%⁴. No significant differences were observed in mortality or readmission rates. Conclusions: Point-of-care ultrasonography is an effective tool for the initial evaluation of acute dyspnea, reducing diagnostic and treatment delays while increasing the proportion of appropriate therapies and providing high diagnostic accuracy for pneumonia, cardiogenic pulmonary edema, and pneumothorax. Its lack of ionizing radiation and low cost support its incorporation into emergency care protocols. Structured training programs and protocol standardization are essential to optimize its clinical application.