Point-of-care ultrasound in the ED is pretty accurate for diagnosis of appendicitis

Reference

Lee SH, Yun SJ. Diagnostic performance of emergency physician-performed point-of-care ultrasonography for acute appendicitis: A meta-analysis. Am J Emerg Med 2019;37(4):696-705.

Synopsis

These authors searched 2 databases and the bibliographies of the included articles to identify studies that studied children and adults with right lower quadrant pain evaluated with POCUS and used surgical findings as the gold standard. Two investigators independently assessed studies for inclusion. They also assessed the risk of bias for the included studies and resolved disagreements through discussion. The authors included a total of 17 studies with 2385 patients. In 3 of the studies, an appendix diameter greater than 7 mm was the criterion for appendicitis; the other 14 studies used 6 mm. The included studies were generally of low to moderate risk of bias; none were seriously flawed. The range of appendicitis was 24% to 75%. Overall, POCUS had decent sensitivity (84%; 95% CI 72% - 92%) and specificity (91%; 85% - 95%), which translates to a positive likelihood ratio (LR+) of 9.3 (4.8 - 18.4) and a negative likelihood ratio (LR-) of 0.18 (0.08 - 0.33). In children, POCUS was even better: 95% sensitivity (75% - 99%), 95% specificity (85% - 98%), LR+ 19.4 (5 - 99), and LR- 0.05 (0.01 - 0.29). The authors found, however, significant heterogeneity in the data. Finally, in the studies that compared POCUS with radiologist-performed ultrasound, the authors found no statistically significant difference in accuracy.