CLINICAL QUESTION: Is cardiopulmonary point-of-care ultrasonography (POCUS) associated with reduced hospital lengths of stay (LOS) in patients with undifferentiated dyspnea?
BACKGROUND: POCUS has been shown to have high diagnostic specificity and sensitivity for a variety of cardiopulmonary conditions, in some studies directly outperforming traditional stethoscope and chest X-ray-based evaluation. However, the adoption of POCUS in clinical care has been inconsistent. One barrier may be the limited evidence regarding the impact of POCUS on management decisions and subsequent outcomes like hospital LOS.
STUDY DESIGN: Stepped-wedge-cluster-design randomized trial
SETTING: A tertiary care hospital in New Jersey
SYNOPSIS: Providers were divided into five clusters (the five medicine, teaching, and hospitalist teams). At the start of the study, all five clusters were in the control group: none of the physicians routinely performed cardiopulmonary POCUS. Over the course of the study, clusters were moved over one at a time from the control to the intervention group, at which point cardiopulmonary POCUS would begin to be routinely implemented. At the conclusion of the study, all five clusters were in the intervention group. A total of 114 hospitalizations that occurred under the care of the control groups were included, and a total of 102 hospitalizations that occurred under the care of the intervention groups were included. Propensity score matching was then employed to obtain well-matched cohorts of 84 hospitalizations in each group for comparison.
Because the distribution of hospital LOS is typically right-skewed, a two-component gamma mixture model was used (essentially dividing hospitalizations into short stays and long stays in both groups). When comparing short-stay hospitalizations, POCUS use was associated with a 1.16-day reduction in LOS (90% credible interval of 0.03 to 2.31 days). When comparing long-stay hospitalizations, POCUS use was associated with a 14.30-day reduction in LOS (90% credible interval of 3.86 to 30.05 days).
One major limitation was the use of trained ultrasonographers and remote cardiologists to supplement hospitalist POCUS use, which may not be reproducible in other hospital settings. Additionally, this was a single-center study. Larger, multi-center trials are needed to validate these findings.
BOTTOM LINE: Cardiopulmonary POCUS has the potential to significantly reduce hospital LOS for patients with undifferentiated dyspnea. Practice patterns need to be tailored to individual hospital settings, but these results support wider adoption of cardiopulmonary POCUS.
CITATION: Maganti K, et al. Cardiopulmonary point-of-care ultrasonography for hospitalist management of undifferentiated dyspnea. JAMA Netw Open. 2025;8(9):e2530677. doi: 10.1001/ jamanetworkopen.2025.30677. Erratum in: JAMA Netw Open. 2025;8(10):e2543834. doi: 10.1001/jamanetworkopen.2025.43834.
Dr. Terng is a hospitalist and instructor of medicine at Columbia University Medical Center in New York.