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How accurate is point-of-care ultrasound for detecting paediatric appendicitis? A systematic review and meta-analysis
Bethaney Miller1, David McCreary2, Jon Rees3
1Paediatric Emergency Department, Sunderland Royal Hospital, Sunderland, UK.
Insights
Point-of-care ultrasound (POCUS) effectively diagnoses appendicitis in children, showing 85.6% sensitivity and 90.2% specificity. However, POCUS alone is not sufficient to rule out appendicitis, requiring further research.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Ultrasound Technology
Background:
- Appendicitis is a common surgical emergency in children.
- Accurate and timely diagnosis is crucial to prevent complications.
- Computed tomography (CT) scans are often used but involve radiation exposure.
Purpose of the Study:
- To assess the diagnostic accuracy of point-of-care ultrasound (POCUS) for appendicitis in pediatric patients.
- To evaluate the impact of POCUS on emergency department length of stay and CT utilization.
Main Methods:
- Systematic review and meta-analysis of studies up to February 2025.
- Included patients presenting with suspected appendicitis who underwent POCUS.
- Assessed study quality using the Quality Assessment Tool for Diagnostic Accuracy Studies.
Main Results:
- Eight studies with 993 patients were analyzed.
- Pooled sensitivity for POCUS was 85.6% (95% CI 68.9% to 94.1%).
- Pooled specificity was 90.2% (95% CI 86.5% to 93.0%).
- Significant variability in sensitivity (53%-100%) and less in specificity (82%-95.2%).
Conclusions:
- POCUS is an effective tool for diagnosing pediatric appendicitis.
- Its moderate sensitivity suggests it should not be used alone to exclude appendicitis.
- Further studies are needed to confirm its role in ruling out appendicitis and its impact on healthcare resource utilization.
Objectives:
Primary: To evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) in the diagnosis of appendicitis in paediatric patients presenting with suspected appendicitis.Secondary: To investigate how the use of POCUS affects length of stay in the paediatric emergency department and CT utilisation.
Methods:
We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) up until February 2025 for studies involving patients presenting to the paediatric emergency department with suspected appendicitis, who underwent POCUS. Studies were assessed for risk of bias using the Quality Assessment Tool for Diagnostic Accuracy Studies framework. The primary outcome of interest was the ability of POCUS to detect appendicitis in terms of sensitivity and specificity.
Results:
Eight studies were included encompassing 993 patients. Calculated pooled sensitivity was 85.6% (95% CI 68.9% to 94.1%) with a specificity of 90.2% (95% CI 86.5% to 93.0%). There was a wide range of reported sensitivities for POCUS, ranging from 53% to 100%. There was less variation in reported specificities that ranged from 82% to 95.2%. The studies analysed were of variable quality with the reference standard and flow and timing being the main areas subject to bias.
Conclusions:
Based on the findings of this systematic review and meta-analysis, it is reasonable to conclude that POCUS can be used as an effective tool to diagnose paediatric appendicitis. With a moderately high sensitivity, it may not be recommended to be used to exclude appendicitis based on POCUS findings alone. Further prospective studies evaluating the reliability of POCUS in excluding appendicitis, either alone or when combined with a clinical prediction rule, are required. Secondary findings from this study demonstrate that POCUS may result in a reduced length of stay in the paediatric emergency department and lead to a reduction in CT utilisation, though insufficient data were available to draw firm conclusions in relation to this.
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