Nurse-Led Ultrasound at Point of Care (POCUS) in Emergency and Critical Care: Accuracy and Outcomes

Abstract

Background:
Nurse-led point of care ultrasound (POCUS) is increasingly used in emergency and critical care where rapid bedside diagnostics and procedural support are essential. Its accuracy and clinical impact across settings remain underexplored.
Methods:
We systematically searched PubMed and Scopus from inception to 28 February 2025 for clinical trials and cohort studies evaluating nurse-performed POCUS in adult and pediatric emergency or intensive care. Eligible outcomes included diagnostic accuracy, vascular or procedural success, and patient-centered metrics. Data were extracted in duplicate and synthesized narratively according to PRISMA guidelines.
Results:
Eleven studies (3 randomized trials, 8 cohorts) enrolling 50–302 participants each were included. Nurse FAST for trauma achieved sensitivity 84.4% (95% CI 72.1–92.2) and specificity 98.4% (94.9–99.6). Nurse lung ultrasound in dyspnea showed sensitivity 95.3% (92.6–98.1) and specificity 88.2% (84.0–92.4). For vascular access, ultrasound guidance increased first-attempt success (odds ratio 2.52; 95% CI 1.09–5.92). In arterial puncture, ultrasound reduced procedure time and complications compared with palpation. Management changes were reported in 26–84% of cases, particularly in fluid resuscitation and respiratory care. No study demonstrated mortality benefits, but adverse events were rare.
Conclusions:
Nurse-led POCUS demonstrated strong diagnostic accuracy, improved procedural success, and frequently informed management decisions across emergency and critical care. Wider adoption requires standardized training, competency assessment, and larger multi-center evaluations to determine patient-level outcomes.