Impact of Multisystem Point-of-Care Ultrasonography in Guiding Clinical Decision Making and Interventions in an Indian Emergency Department: A Retrospective Study

Background Point-of-care ultrasonography (POCUS) has evolved from bulky, stationary machines to compact handheld devices that can be used repeatedly without exposing patients to radiation. This makes it easier for clinicians to reassess patients over time and adjust diagnoses as clinical conditions change. It is now widely used in the emergency department (ED) as a quick bedside tool that supports immediate clinical evaluation, often avoiding the need to transfer patients to the radiology department. Its value is greatest in high-acuity situations, where timely decisions can be life-saving. Most of the available data, especially from India, focuses on individual applications rather than their broader, multisystem use in routine practice. Therefore, there is a need for research in that arena of POCUS. This study describes the association between multisystem POCUS findings and documented changes in diagnosis and management, and evaluates diagnostic accuracy against a composite clinical reference standard. Materials and methods This retrospective observational study was conducted in the ED of Mahatma Gandhi Mission (MGM) Medical College and Hospital, Navi Mumbai, an Indian tertiary healthcare center. The data used in this study were collected retrospectively from the hospital electronic medical records for all patients who underwent POCUS between January 2025 and June 2025. Different POCUS applications like extended focused assessment with sonography for trauma (eFAST), lung ultrasound (LUS), cardiac ultrasound, inferior vena cava assessment (IVC assessment), optic nerve sheath diameter (ONSD) measurement, transcranial Doppler (TCD), and airway ultrasound were included. Results Five hundred and seventy-three patients were screened, and 284 patients undergoing 390 POCUS examinations were included, among whom there was a change in diagnosis in 66 examinations (16.9%) and a change in management in 85 examinations (21.8%). Both outcomes changed simultaneously in 66 examinations (16.9%), management was refined without a diagnosis change in 19 examinations (4.9%), and the original plan was confirmed in 305 examinations (78.2%). ONSD measurement and TCD showed the highest rate of change in management (48.6% and 47.1%, respectively). IVC assessment had the highest accuracy (92.8%) and was the only application meeting both rule-in (positive likelihood ratio 12.54; 95% confidence interval 3.30-47.66) and rule-out (negative likelihood ratio 0.077; 95% confidence interval 0.030-0.200) thresholds. The TCD positive likelihood ratio (6.22; 95% confidence interval 0.96-40.23) was not statistically robust because the confidence interval crossed 1.0. Conclusion In this single-centre retrospective cohort, multisystem POCUS was associated with documented changes in diagnosis and management in a subset of emergency department examinations. Diagnostic performance varied across applications, with the most robust estimates observed for IVC assessment, while those for TCD and airway POCUS were limited by small sample sizes. Taken together, POCUS should be incorporated across EDs in India where it has the potential to improve patient care in a most practical and impactful way.