Diagnostic accuracy of surgeon-performed point-of-care ultrasonography using Tokyo guidelines criteria for acute cholecystitis: a prospective diagnostic accuracy study

Acute calculous cholecystitis is a common surgical emergency. In health systems with delayed or limited access to radiology-performed ultrasonography, diagnostic delays may increase complications, length of stay, and resource utilization. Surgeon-performed point-of-care ultrasonography may expedite evaluation; however, its diagnostic accuracy when incorporated into structured diagnostic frameworks such as the Tokyo criteria remains uncertain. We conducted a prospective observational diagnostic accuracy study in the emergency department of a second-level referral hospital. Adult patients with clinical suspicion of acute cholecystitis were enrolled during recruitment shifts. All participants underwent standardized clinical evaluation, surgeon-performed point-of-care ultrasonography using a handheld device, and radiology-performed ultrasonography. The reference standard was pragmatic: histopathology for operated patients and structured clinical follow-up for up to 2 months for nonoperated patients. Diagnostic performance (sensitivity, specificity, likelihood ratios, predictive values, and post-test probability) was calculated for surgeon-performed ultrasonography alone, radiology-performed ultrasonography, and the Tokyo criteria using either imaging modality. A total of 170 patients were included (mean age 42.8 years; 78.8% women). Surgeon-performed point-of-care ultrasonography considered positive with at least 1 sonographic finding demonstrated a sensitivity of 96.4% and specificity of 55.6%, with strong rule-out capability (negative likelihood ratio 0.06; negative post-test probability approximately 1%). Radiology-performed ultrasonography showed a sensitivity of 82.1% and specificity of 64.1%. When integrated into the Tokyo criteria, surgeon-performed ultrasonography yielded a sensitivity of 78.6% and specificity of 80.3%, comparable to Tokyo criteria using radiology-performed ultrasonography, with no statistically significant difference in paired classification. Surgeon-performed point-of-care ultrasonography demonstrated excellent sensitivity and rule-out performance. When incorporated into the Tokyo diagnostic criteria, its diagnostic performance was comparable to radiology-performed ultrasonography, supporting its use as a practical diagnostic alternative in emergency surgical settings with limited access to radiology services.