A new study in the Archives of the Cardiovascular Disease highlights the clinical value of hand-carried ultrasound (HCU) in improving the accuracy of volaemia assessment in geriatric patients, where traditional clinical and biological evaluations often fall short. Conducted in a single-center geriatric care setting, the prospective observational study demonstrated that bedside HCU, performed by trained geriatricians, offers critical insights into a patient's fluid status, leading to more precise treatment decisions.
The study involved 102 hospitalized elderly patients (median age 89 years) whose volume status (hypovolaemia, euvolaemia, or hypervolaemia) was uncertain based on initial clinical and biological evaluations. Using HCU, geriatricians assessed the inferior vena cava (IVC) diameter and its collapsibility index to estimate right atrial pressure—a surrogate for overall fluid volume.
Findings showed that the HCU-based volaemia assessment differed from clinical and biological evaluation in 53% of cases (n = 54; 95% CI: 43–63%), with poor agreement between the methods (Cohen’s κ = 0.15). Notably, most discrepancies involved cases where clinical assessment suspected hypervolaemia, but HCU revealed euvolaemia. This reevaluation changes the management in 36 patients (35%), including the initiation or discontinuation of diuretics or fluids.
The absence of jugular vein distension was significantly associated with the discrepancies.