Internal Medicine faculty and GME trainees co-authored an article published in JAMA on February 23rd, 2026
University of Utah Internal Medicine faculty and GME trainees co-authored an article that was published in JAMA on February 23rd, 2026. Co-authors include DGIM professors Stacy Johnson, MD; and Edmund Liles, MD; DGIM clinical instructor Emily Worrall, MD; DGIM assistant professors Benjamin Drum, MD, PhD; Mark Kelly, MD; and Audrey York, MD; internal medicine GME trainee Bryce La Course, MD; and medicine-pediatrics GME trainee Jennifer Martins, MD.
The article, titled Does This Patient Have Volume Overload? The Rational Clinical Examination, sought answers to the question: "Which physical examination, ultrasonographic techniques, and laboratory studies have the best evidence for determining volume overload in spontaneously breathing patients?"
Intravascular volume overload is a state of abnormal expansion of the intravascular compartment, and accurately assessing this directly impacts decisions about fluid management in patients with volume overload. The team aimed to identify the most accurate method in assessing volume overload from the following: (1) clinical examination; (2) radiographic findings; (3) POCUS examination; or (4) labs.
In their examination, the authors conducted a meta analysis of peer-reviewed English-language primary studies found on MEDLINE between 1946 to January 6, 2026. 33 articles met the selection criteria, and were reviewed to obtain the research team's findings that "A BNP level of 100 ng/mL or higher and the presence of vascular congestion on chest radiography may be the most useful tests to identify patients with volume overload. Absence of pulmonary B-lines using POCUS or BNP levels lower than 100 ng/mL may be the most useful findings to exclude volume overload."