Background: The role of bedside ultrasound to evaluate traumatic cardiac injury and aortic aneurysm rupture is well established. However, there is a lack of robust data to support the accuracy of use of immediate ultrasonography procedures at the point of care to detect other cardiovascular conditions. Aim of this umbrella meta-analysis was to evaluate a pooled sensitivity and specificity of use of Point-of -care Ultrasound (POCUS) to diagnose and predict the prognosis of cardiovascular conditions [cardiac arrest and deep vein thrombosis (DVT)] compared to gold standard procedures.

Methods: A systematic search was performed following PRISMA guidelines of meta-analysis studies that evaluated the diagnostic accuracy of Point-of-Care Ultrasound (POCUS) in detecting cardiovascular diseases and their prognosis in conditions compared to gold standard methods using PubMed database from inception to the year 2021. We performed meta of meta-analysis using Review manager 5.3 and OpenMetaAnalyst to estimate sensitivity and specificity using random-effects models and DerSimonian-Laird test, with 95% Confidence interval (CI). Interstudy variability (heterogeneity) was calculated and forest plots were obtained. Area under ROC was created from sensitivity and specificity of POCUS.

Results: Three meta-analysis studies were included with a total of 33 studies and 4216 patients (two meta-analysis studies for cardiac arrest with 25 studies and 3181 patients, one meta-analysis study for DVT with 8 studies and 1035 patients). We found a pooled sensitivity of 81.7% (95%CI:36.7%-97.2%) (I2=91.52%; p< 0.001) and a pooled specificity of 90.1% (79.0%-95.6%) (I2= 98.55%; p< 0.001) of POCUS in accurately diagnosing cardiovascular diseases compared to the gold standard methods.

Conclusions: In conclusion, our meta-meta-analysis suggests higher sensitivity and specificity of POCUS to diagnose and predict cardiovascular conditions accurately. More studies regarding other cardiovascular conditions are needed to derive substantial data.

IMAGE 1: Sensitivity and specificity of POCUS in diagnosing CVDs

IMAGE 2: Area under ROC for POCUS