Point-of-care ultrasound diagnostic accuracy for pediatric appendicitis in emergency departments

This is a systematic review and meta-analysis of diagnostic accuracy studies. The population consisted of pediatric patients presenting to the paediatric emergency department with suspected appendicitis. The setting was the paediatric emergency department across the included studies. The total sample size was 993 patients across 8 studies. The intervention evaluated was point-of-care ultrasound (POCUS); a comparator was not reported in the source data. The primary outcome was the diagnostic accuracy of POCUS for detecting appendicitis, specifically sensitivity and specificity. The main results showed a pooled sensitivity of 85.6% (95% CI 68.9% to 94.1%) and a pooled specificity of 90.2% (95% CI 86.5% to 93.0%). These results indicate a positive diagnostic performance, but the evidence is based on a meta-analysis of 8 studies with variable quality.

Key secondary outcomes included length of stay in the paediatric emergency department and CT utilisation. However, the source data indicates insufficient data to draw firm conclusions on these secondary outcomes. No specific numerical results for length of stay or CT utilisation are reported in the input.

Safety and tolerability findings are not reported. The source states that adverse events, serious adverse events, discontinuations, and tolerability were not reported. Therefore, no safety data can be presented from this meta-analysis.

These results can be compared to prior landmark studies in pediatric appendicitis diagnosis. The source notes that pooled effect sizes are based on a meta-analysis of 8 studies, but individual study sensitivities ranged widely from 53% to 100%. This variability highlights the heterogeneity in the evidence base. The current meta-analysis synthesizes this data but does not introduce new primary trial data.

Key methodological limitations are explicitly noted. The studies were of variable quality, with reference standard and flow and timing being main areas subject to bias. There is insufficient data to draw firm conclusions on secondary outcomes (length of stay and CT utilisation). These limitations affect the certainty of the findings.

Clinical implications are that POCUS can be used as an effective tool to diagnose paediatric appendicitis. However, due to moderately high sensitivity, it may not be recommended to exclude appendicitis based on POCUS findings alone. The practice relevance states that clinicians should not conclude that POCUS can reliably exclude appendicitis based on these findings, and should not overstate the evidence on length of stay or CT utilisation due to insufficient data.

Questions remain unanswered. The comparator for POCUS was not reported, so its performance relative to other diagnostic methods is unclear. The impact of POCUS on clinical decision-making, such as reducing unnecessary CT scans or shortening emergency department stays, cannot be determined from the available data. Future research should address these gaps with higher-quality studies and standardized protocols.