Point-of-care ultrasound for evaluating acute dyspnoea in emergency departments: Systematic review and meta-analysis

Acute dyspnoea is a common yet diagnostically complex presentation in emergency departments (EDs), representing approximately 2.4% of all visits. Traditional diagnostic tools-clinical assessment, chest radiography, and laboratory tests-may lack the precision required for timely and accurate diagnosis. Point-of-care ultrasound (POCUS) offers real-time, bedside imaging and has emerged as a promising tool to address these limitations.

To evaluate the diagnostic accuracy and clinical effectiveness of POCUS vs conventional modalities in adults with acute dyspnoea in the ED.

A comprehensive literature search was conducted across PubMed, EBSCO Host, MAG Online Library, Elsevier, and ProQuest without date restrictions. Studies were included if they involved adult ED patients undergoing POCUS for dyspnoea evaluation. Following PRISMA 2020 guidelines and PROSPERO registration (CRD42025649145), eligible studies were assessed using QUADAS-2, and diagnostic performance was analysed using MetaDisc software. Pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratio (DOR), and receiver operating characteristic curves were calculated.

Out of 581 identified records, 44 studies met the inclusion criteria, with 19 included in the meta-analysis. The pooled sensitivity of POCUS was 85.6% (95%CI: 84.0%-87.2%) and specificity was 80.8% (95%CI: 79.0%-82.5%). The DOR was 68.09 (95%CI: 27.07-171.28), and the negative likelihood ratio was 0.14 (95%CI: 0.085-0.231), indicating strong potential to rule out serious pathology. Substantial heterogeneity was noted, mainly due to operator variability, study design, and diagnostic protocols.

POCUS offers accurate, rapid, and cost-effective evaluation of acute dyspnoea in EDs. Standardised training and further research on outcomes, protocols, and underrepresented populations are essential for consistent, effective implementation.