Diagnostic Accuracy of Point-of-Care Ultrasound (POCUS) for Suspected Acute Appendicitis in Pediatric and Adult Emergency Departments: A Systematic Review and Meta-Analysis

Acute appendicitis is a common surgical emergency that often requires diagnostic imaging. While computed tomography (CT) is highly accurate, it involves ionizing radiation and potential delays. Point-of-care ultrasound (POCUS), performed by emergency physicians, offers a rapid, radiation-free alternative, but its diagnostic accuracy varies across studies. This systematic review and meta-analysis evaluates the diagnostic performance of POCUS for acute appendicitis in pediatric and adult populations. Major databases were searched for prospective and retrospective studies evaluating POCUS for appendicitis performed by emergency physicians. The primary outcomes were sensitivity, specificity, and likelihood ratios. Quality assessment was performed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. Data were synthesized using a bivariate random-effects model, and a Hierarchical Summary Receiver Operating Characteristic (HSROC) curve was generated. Subgroup analyses explored heterogeneity based on patient population and operator experience. Fifteen studies involving 2,021 patients were included. POCUS demonstrated a pooled sensitivity of 0.78 (95% CI: 0.69-0.85) and a pooled specificity of 0.89 (95% CI: 0.83-0.93). The positive likelihood ratio was 7.22 (95% CI: 4.51-11.54), and the negative likelihood ratio was 0.25 (95% CI: 0.17-0.36). Significant heterogeneity was observed, partly explained by operator experience, with fellowship-trained physicians achieving higher accuracy than residents. Publication bias was detected via Deeks' funnel plot asymmetry test (P < 0.01). POCUS performed by emergency physicians is a highly specific and moderately sensitive tool for diagnosing acute appendicitis. A positive scan reliably rules in the disease, potentially reducing the need for further imaging. However, a negative scan is insufficient to rule out appendicitis, requiring secondary evaluation. Structured training and experience are critical for optimizing diagnostic performance.