Comparative Analysis Of Point-Of-Care Ultrasound And, Conventional Clinical Assessment For Volume Status Evaluation In Newly Admitted Hospital Patients

Abstract

Background: Accurate volume status assessment remains a fundamental challenge in managing newly admitted hospital patients. Traditional clinical assessment methods demonstrate significant inter-observer variability and limited diagnostic accuracy. Point-of-care ultrasound (POCUS), particularly inferior vena cava (IVC) assessment, has emerged as a promising non-invasive bedside tool, yet its comparative effectiveness against conventional methods in Saudi Arabian healthcare requires investigation.

Objectives: This study compares the diagnostic accuracy, clinical utility, and feasibility of POCUS-guided IVC assessment versus conventional clinical evaluation for determining volume status in newly admitted hospital patients. Secondary objectives include evaluating POCUS impact on clinical decision-making, fluid management strategies, and patient outcomes within Saudi Arabian tertiary care settings.

Methods: This prospective observational comparative study will enroll 200 adult patients admitted to emergency departments and intensive care units at tertiary hospitals in Riyadh. Patients undergo simultaneous assessment using POCUS (IVC diameter and collapsibility/distensibility indices) and conventional methods (physical examination, vital signs, clinical gestalt). The reference standard comprises hemodynamic response to fluid challenge. Primary outcomes include sensitivity, specificity, and area under receiver operating characteristic curve for predicting fluid responsiveness. Secondary outcomes encompass inter-rater reliability, assessment completion time, and clinical decision concordance.

Results: Based on existing literature, POCUS-guided IVC assessment should demonstrate superior diagnostic accuracy compared to conventional methods, with expected sensitivity of 75-88% and specificity of 73-86% for predicting fluid responsiveness. The caval index cutoff of 40-50% should show optimal performance. POCUS is expected to reduce inter-observer variability and provide more objective, reproducible measurements compared to clinical gestalt, potentially improving fluid management decisions.

Conclusions: Integration of POCUS-guided volume assessment represents significant advancement in bedside hemodynamic evaluation. This study will provide crucial evidence for Saudi Arabian healthcare institutions regarding POCUS protocol implementation, potentially establishing new care standards combining objective ultrasound measurements with traditional clinical acumen to optimize patient management and resource utilization.