• Bram Kok, David Wolthuis, Frank Bosch, Hans van der Hoeven, and Michiel Blans.
• Department of Internal Medicine, Radboudumc, Geert Grooteplein Zuid 10, Nijmegen, GA 6525, the Netherlands. Electronic address: bram.kok@radboudumc.nl.
• Eur. J. Intern. Med. 2022 Dec 1; 106: 9389-38.

BackgroundPoint-of-care ultrasound (POCUS) has been adopted as a powerful tool in acute medicine. This systematic review aims to critically appraise the existing literature on point-of-care ultrasound in respiratory or circulatory deterioration.MethodsOriginal studies on POCUS and dyspnea, nontraumatic hypotension, and shock from March 2002 until March 2022 were assessed in the PubMed and Embase Databases. Two reviewers independently screened articles for inclusion, extracted data, and assessed the quality of included studies using an established checklist.ResultsWe included 89 articles in this review. Point-of-care ultrasound in the initial workup increases the diagnostic accuracy in patients with dyspnea, nontraumatic hypotension and shock in the ED, ICU and medical ward setting. No improvement is found in patients with severe sepsis in the ICU setting. POCUS is capable of narrowing the differential diagnoses and is faster, and more feasible in the acute setting than other diagnostics available. Results on outcome measures are heterogenous. The quality of the included studies is considered low most of the times, mainly because of performance and selection bias and absence of a gold standard as the reference test.ConclusionWe conclude that POCUS contributes to a higher diagnostic accuracy in dyspnea, nontraumatic hypotension, and shock. It aides in narrowing the differential diagnoses and shortening the time to correct diagnosis and effective treatment.Trial RegistryINPLASY; Registration number: INPLASY202220020; URL: https://inplasy.com/.Copyright © 2022 The Author(s). Published by Elsevier B.V. All rights reserved.

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