Table 1 Study characteristics
From: Diagnostic accuracy of point-of-care ultrasound for shock: a systematic review and meta-analysis
Study | Design, no. of patients (location) | Clinical setting | Definition of circulatory failure | US protocol | US Physician | Reference standard |
|---|---|---|---|---|---|---|
Bagheri-Hariri et al. [40] | Prospective Cohort, one center, 25 patients (Iran) | Emergency department | SBP < 90 mmHg or shock indexa > 1.0 with clinical hypoperfusion symptoms | Multi-organ POCUS (observed in order: heart/IVC, jugular veins, thoracic and abdominal cavities, lungs/deep veins, aorta)b | Emergency physicians with credentials for the emergency department ultrasound | Clinical diagnosis using all medical information |
Ghane et al. [33] | Prospective Cohort, one center, 77 patients (Iran) | Emergency department | SBP < 100 mmHg or shock indexa > 1.0 | Multi-organ POCUS (observed in order: heart/IVC, jugular veins, thoracic and abdominal cavities, lungs/deep veins, aorta) b | An emergency physician with five years of experience with more than 200 ultrasonographic exams per year | Clinical diagnosis after admission to the medical units (internal medicine, cardiology, or surgery) by board-certified specialists |
Shokoohi et al. [43] | Prospective Cohort, one center, 118 patients (USA) | Emergency department | SBP < 90 mmHg after an initial fluid resuscitation (> 1L of normal saline) | Multi-organ POCUS (no order specified: heart, IVC, thoracic and abdominal cavities, and lung) | An ultrasound-trained attending physician (including ultrasound fellows) with extensive experience in emergency and critical care ultrasound | Clinical diagnosis by chart review by two board-certified intensivists, blinded to the results of POCUS |
Agmy et al. [41] | Unknown, one center, 63 patients (Egypt) | Intensive care unit | Circulatory shock patients (definition was unknown) | Multi-organ POCUS (observed in order: heart and lung)c | Unclear | Clinical diagnosis using all medical information |
Nazerian et al. [35] | Prospective Cohort, two center, 105 patients (Italy) | Emergency department | SBP < 90 mmHg or a drop of SBP > 40 mmHg for more than 15 min, with signs of end-organ hypoperfusion (cold extremities, UO < 30 mL/h, altered mental status, profound asthenia with fatigue and malaise, or respiratory distress), with suspected PE | Multi-organ POCUS (no order specified: heart and deep veins) | Sonographers with more than 2 years’ experience in cardiac and venous US on critically ill patients | Clinical diagnosis by an expert in PE who independently reviewed all the available clinical and imaging data including multidetector computed tomography pulmonary angiography |
Elbaih et al. [38] | Prospective Cohort, one center, 100 patients (Egypt) | Emergency department | Unstable polytrauma patients (definition of unstable was unknown) | Multi-organ POCUS (observed in order: heart/IVC, jugular veins, thoracic and abdominal cavities, lungs/deep veins, aorta)b | Unclear | Clinical diagnosis using all medical information |
Tesfaye et al. [42] | Prospective Cohort, one center, 93 patients (Ethiopia) | Emergency department | Hypotension (definition of hypotension was unknown) | Multi-organ POCUS (observed in order: heart/IVC, jugular veins, thoracic and abdominal cavities, lungs/deep veins, aorta)b | Unclear | Clinical diagnosis after full evaluation |
Daley et al. [37] | Prospective Cohort, six centers, 136 patients (USA) | Emergency department | Tachycardia and/or hypotension with suspected PE (definition of tachycardia and hypotension was unknown) | Heart including the measurement of TAPSEd | Emergency physicians or study investigators (including medical students) trained in FOCUS | Computed tomography angiography |
Rahulkumar et al. [36] | Prospective Cohort, one center, 97 patients (India) | Emergency department | SBP < 90 mmHg and shock indexa > 1.0 | Multi-organ POCUS (observed in order: heart/IVC, jugular veins, thoracic and abdominal cavities, lungs/deep veins, aorta) b | An emergency physician expert in emergency medicine ultrasound | Clinical diagnosis using all medical information by the consultants of medicine or surgery department |
Javali et al. [39] | Prospective Cohort, one center, 100 patients (India) | Emergency department | SBP < 90 mmHg and shock index a > 1 with the presence of at least one of the following signs or symptoms of hypoperfusion unresponsiveness, altered mental status, syncope, respiratory distress, generalized fatigue, severe chest pain or abdominal pain | Multi-organ POCUS (no order specified: heart, lung, free fluid in the peritoneal cavity, aorta, IVC, and femoral vein) | A trained emergency physician (unclear regarding ultrasound experience) | Clinical diagnosis after admission to the medical units (internal medicine, cardiology, or surgery) by board-certified specialists, blind to the diagnoses in the emergency department |
Keefer et al. [32] | Prospective Cohort, six centers, 135 patients (North America and South Africa) | Emergency department | Sustained SBP < 100 mmHg or shock indexa > 1.0 | Multi-organ POCUS (observed in order: heart/IVC, jugular veins, thoracic and abdominal cavities, lungs/deep veins, aorta) b | POCUS-trained emergency physicians | Clinical diagnosis by chart review by two clinicians, blinded to the initial sonographer, and point-of-care ultrasonography findings and diagnosis |
Zieleskiewicz et al. [34] | Prospective Cohort, one center, 83 patients (France) | General ward | MAP < 65 mmHg or HR < 40 bpm or HR > 120 bpm or UO < 50 ml/4 h | Multi-organ POCUS (no order specified: heart, IVC, lung, thoracic　cavity, and the deep veins if required) | ICU physicians trained in ultrasound | Clinical diagnosis by chart review including physical examinations and blood and imaging tests by two physicians blinded of the initial diagnoses made at the bedside |