When gastric point-of-care ultrasound changes management: a research letter

Gastric point-of-care ultrasound (POCUS) is increasingly used to assess aspiration risk, but studies differ in whether ultrasound is used to validate the technique, characterize gastric contents in populations, or guide bedside clinical decisions. We performed a focused secondary analysis of 65 studies from the study-level extraction associated with a previously published ASRA Pain Medicine narrative review to determine how often gastric POCUS studies evaluated or reported changes in management. Studies were categorized by primary study purpose as foundational/validation/diagnostic-performance/reliability, clinical POCUS/decision-impact, or population/intervention research. Of 65 studies, 2 were clinical POCUS/decision-impact studies, 9 were foundational/validation studies, and 54 were population/intervention studies. Management-change status was reported or extractable in 8 studies and prespecified in 3; all 8 reported at least one actual management change, with rates ranging from 0.4% to 46%. Both clinical POCUS studies prespecified a management change, with reported change rates of 5.0% and 18.9%, respectively. Reported changes included rapid sequence induction, airway modification, postponement or cancellation, conversion to local/regional anesthesia, and more liberal or conservative aspiration-risk management. No study clearly linked management change to patient-centered outcomes. Future clinical gastric POCUS studies should prospectively define the indication, pre-scan plan, scan findings and decision thresholds, post-scan decision, and reason for change or non-change, while evaluating downstream patient-centered outcomes, resource utilization, and potential harms.