Diagnostic Accuracy of Point-of-Care Ultrasound in Acute Abdominal Pain: A Systematic Review in Emergency and Internal Medicine Settings"
Abstract
Abstract
Background: Acute abdominal pain is a frequent presentation in emergency and internal medicine, accounting for up to 10% of all emergency department visits. Early diagnosis is critical to guide timely interventions and reduce morbidity. Point-of-care ultrasound (POCUS) has emerged as a rapid, bedside tool to support diagnostic decision-making. This systematic review assesses the diagnostic accuracy of POCUS across common causes of acute abdominal pain.
Methods: We systematically searched PubMed, Scopus, and Web of Science for studies published between 2000 and 2024 evaluating the diagnostic performance of POCUS in adult patients presenting with acute abdominal pain. We included 37 studies comprising 8,465 patients across diverse settings. Pooled sensitivity, specificity, and area under the curve (AUC) values were calculated for key diagnostic categories including appendicitis, cholecystitis, bowel obstruction, and abdominal aortic aneurysm (AAA).
Results:
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Appendicitis: 14 studies (n=3,120); pooled sensitivity 84.6% (95% CI: 79.2–89.0%), specificity 91.3% (95% CI: 86.5–94.7%), AUC 0.91.
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Cholecystitis: 9 studies (n=2,106); sensitivity 88.1%, specificity 92.5%, AUC 0.93.
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Bowel obstruction: 7 studies (n=1,540); sensitivity 81.2%, specificity 88.4%, AUC 0.89.
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AAA: 6 studies (n=925); sensitivity 96.7%, specificity 99.1%, AUC 0.98.
Overall diagnostic accuracy improved when POCUS was performed by trained emergency physicians or internal medicine residents with ≥1 year experience.
Conclusion: POCUS demonstrates high diagnostic accuracy, particularly for AAA and cholecystitis, and serves as a reliable first-line modality in emergency and internal medicine settings. Sensitivity ranges from 81% to 97% and specificity from 88% to 99% depending on the condition. Given its bedside applicability and rapid turnaround, POCUS should be incorporated into early diagnostic pathways for acute abdominal pain. Future research should focus on standardized training and protocol development to optimize POCUS implementation.
