Applications and indications of point-of-care ultrasound in emergency department encounters involving palliative care patients

Kamonwon Ienghong; Korakot Apiratwarakul; Sukanya Khemtong; Lap Woon Cheung

doi:10.3389/fmed.2025.1719679

Applications and indications of point-of-care ultrasound in emergency department encounters involving palliative care patients

Front Med (Lausanne). 2025 Nov 20:12:1719679. doi: 10.3389/fmed.2025.1719679. eCollection 2025.

Authors

Kamonwon Ienghong¹, Korakot Apiratwarakul¹, Sukanya Khemtong¹, Lap Woon Cheung²

Affiliations

¹ Department of Emergency Medicine, Faculty of Medicine, Khon Kaen University, Khon Kaen, Thailand.
² Department of Emergency Medicine, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Pokfulam, Hong Kong.

Abstract

Background: Point-of-care ultrasound (POCUS) is a rapid bedside imaging technique that facilitates symptom-focused, targeted care for palliative patients presenting to the emergency department (ED). This study outlines the indications, ultrasound-detected diagnoses, and procedural applications of POCUS in palliative care patients at a tertiary ED in Thailand.

Methods: A retrospective analysis of adult emergency department encounters at Srinagarind Hospital was conducted from January 2020 to December 2024. Patients aged 18 years or older, classified under ICD-10 Z51.5 (palliative care), with documented POCUS examinations in the electronic medical record were included. Demographic data, presenting complaints, triage levels, the purpose of POCUS (diagnostic, procedural guidance, or both), and POCUS findings as recorded by the performing emergency medicine team were collected. Descriptive statistics were used to summarize the findings.

Results: Of 875 emergency department patients classified as palliative, 434 (49.6%) had documented point-of-care ultrasound (POCUS) and were included in the study. The median age was 71 years (range 64-97). Of these, 59.7% were male, and 74.9% had oncological diagnoses. High-acuity triage levels (1-2) accounted for 41.9% of cases. POCUS was primarily used for diagnostic assessment in 74.9% of cases and for procedural support in 42.2% of patients. The most frequently identified conditions were ascites (42.6%) and pleural effusion (11.1%). The most common POCUS-guided procedures were abdominal paracentesis (34.8%) and thoracentesis (7.4%).

Conclusion: POCUS frequently addressed symptom-directed concerns in palliative patients in the emergency department, commonly identifying fluid-related causes of distress and enabling bedside, symptom-relieving procedures. With appropriate training, governance, and prospective evaluation of patient-centered outcomes, POCUS has the potential to enhance acute supportive care for palliative patients across Thailand.

Keywords: decision making; diagnostic techniques and procedures; emergency service; palliative supportive care; ultrasonography.