Portable Ultrasound Outshines Stethoscopes in Study of Breathless Hospital Patients
A new study from Rutgers University and RWJBarnabas Health is challenging one of medicine’s most enduring tools: the stethoscope. Researchers found that bedside ultrasound devices, even when used by clinicians with only limited training, offered faster and more accurate insight for patients admitted with shortness of breath—leading to shorter hospital stays and significant cost savings. The results appeared in JAMA Network Open.
Shortness of breath is among the most common reasons for hospitalization, but it can stem from multiple causes, ranging from heart failure to pneumonia. Traditionally, physicians have relied on stethoscopes, chest x-rays, and lab work to sort out the problem. In this trial, investigators instead armed hospitalists with portable ultrasound probes that plug into smartphones, allowing them to scan the heart and lungs directly at the bedside.
The impact was notable. Patients first examined with ultrasound spent just over eight days in the hospital on average, compared with nearly 12 days for those assessed with standard care. That difference translated into more than 240 bed-days saved and an estimated $751,000 reduction in costs across the study population, without an uptick in readmissions. “The explanation here is simple,” said Partho Sengupta, MD, senior author and chief of cardiology at Rutgers Robert Wood Johnson Medical School. “Ultrasound gives you more information, and more concrete information, about what’s going on.”
Rather than aiming for exhaustive scans, the protocol emphasized efficiency. Hospitalists were trained for just a few hours to capture a handful of cardiac views and perform a six-zone sweep of the lungs, focusing on binary indicators such as whether congestion was present or systolic function was reduced. Exams took 10 to 15 minutes. In practice, most scans were carried out by sonographers and interpreted by cardiologists, but the approach still altered medical decisions in about a third of cases, including changes in treatment plans and new diagnoses.
Sengupta acknowledged that despite its portability—the probe can fit in a coat pocket and attach to a phone—ultrasound has been slow to gain traction during hospital rounds. “Although the ultrasound probe fits in your pocket and attaches to the back of a smartphone, its use in clinical settings remains inconsistent,” he said, citing time pressures and a lack of incentives for hospitalists. The study’s success, he argued, stemmed from its multidisciplinary design, which combined the skills of hospitalists, cardiologists, sonographers, engineers, and data scientists to streamline workflow.
Some of the strongest benefits were seen in patients with longer hospital stays, suggesting that ultrasound-guided triage may be especially effective for complex cases. Still, the authors noted that this was a single-center study and relied heavily on specialized staff. To prove scalability, similar trials will need to be conducted across different hospitals.
Despite these caveats, the study makes a strong case for rethinking how breathlessness is assessed in hospitalized patients. A quick, bedside view of the heart and lungs can provide clarity early in the admission process, enabling clinicians to initiate the right treatment sooner. As Sengupta put it: “When clinicians can see fluid in the lungs, a failing heart or a stiff inferior vena cava in minutes, they can target therapy sooner or rule out a cardiopulmonary cause and look elsewhere.”