ArticleChinese journal of traumatology = Zhonghua chuang shang za zhi2026
HIMAP POCUS protocol for early evaluation of undifferentiated shocked patients at the emergency department: A prospective study of diagnostic accuracy and time efficiency.
Article in Chinese journal of traumatology = Zhonghua chuang shang za zhi, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
purposeRapid and accurate diagnosis of shock etiology is essential for appropriate management in critically ill patients. The heart, inferior vena cava (IVC), Morrison's pouch/focused assessment with sonography for trauma, aorta, pulmonary (HIMAP) protocol utilizes point-of-care ultrasound (POCUS) to evaluate undifferentiated shock. Our study aims to assess the diagnostic performance and feasibility of early application of the HIMAP POCUS protocol during the initial assessment of undifferentiated shocked patients at the emergency department.
methodsThis prospective study included 51 adult patients presenting with undifferentiated shock. Providers performed the HIMAP protocol, and provisional shock diagnoses based on primary assessment and the HIMAP protocol were recorded. These were compared to the final diagnosis based on investigations and consultant opinion. Accuracy, sensitivity, specificity, and positive/negative predictive values were calculated.
resultsAmong the included 51 patients, 29 (56.9%) were male, 11 (21.6%) were smokers, and 23 (45.1%) had a history of hypertension. For hypovolemic shock, the main HIMAP findings were a small IVC diameter <1.7 cm in 14 (56.0%), a high IVC collapsibility index >50% in 23 (92.0%), and no pleural effusion in 23 (92.0%). Septic shock correlated with left ventricle hyperdynamics in 15 (48.4%), and IVC diameter <1.7 cm in 14 (45.2%). Cardiogenic shock is associated with impaired left ventricle contractility in 10 (90.9%), IVC diameter >2.1 cm in 10 (90.9%), and pleural effusion in 6 (54.5%). The HIMAP protocol demonstrated high diagnostic accuracy of 92.2%-100% and predictive values of 85.7%-100% for hypovolemic, septic, obstructive, cardiogenic, and mixed shock types against the final diagnosis.
conclusionThe HIMAP POCUS technique served as an early quick evaluation tool for emergency and acute care clinicians and showed a remarkable diagnostic performance for patients presenting with undifferentiated shock in the emergency department.
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