From Ruling Out to Ruling In: Putting POCUS in Focus

Abstract

Over the past twenty years, the Emergency Department (ED) has transformed from a location that managed patients with acute life-threatening illness or injury to an acute diagnostic center. The advent of rapid and accurate imaging, novel biomarkers, and other innovations concurrent with effects from financial and social forces has supported the development of an acute care system focused on “ruling out” low-frequency, high-mortality events such as acute myocardial infarction, stroke, pulmonary embolism, and aortic dissection. This search for “true-negatives” may result from malpractice fears, readily available technology, or most likely, clinician and patient discomfort with uncertainty. As a result, diagnostic testing is ubiquitous and costs of care continue to rise. A notable example of this trend has been the rapid increase in computed tomography (CT) utilization for patients with renal colic despite little evidence of major improvements in outcomes.

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