Diagnostic Performance of Emergency Physician-Performed Point-Of-Care Ultrasonography for Acute Appendicitis: A Meta-Analysis

Am J Emerg Med. 2019 Apr;37(4):696-705. doi: 10.1016/j.ajem.2018.07.025. Epub 2018 Jul 14.

Abstract

Objective: To assess the sensitivity and specificity of emergency physician-performed point-of-care ultrasonography (EP-POCUS) for diagnosing acute appendicitis (AA).

Material and methods: The PubMed and EMBASE databases were searched, and the diagnostic performance of EP-POCUS was evaluated using bivariate modeling and hierarchical summary receiver operating characteristic curves. Subgroup analysis was performed for pediatric patients to compare EP-POCUS and radiologist-performed ultrasonography (RADUS). Meta-regression analyses were performed according to patient and study characteristics.

Results: In 17 studies (2385 patients), EP-POCUS for diagnosing AA exhibited a pooled sensitivity of 84% (95% confidence interval [CI]: 72%-92%) and a pooled specificity of 91% (95% CI: 85%-95%), with even better diagnostic performance for pediatric AA (sensitivity: 95%, 95% CI: 75%-99%; specificity: 95%, 95% CI: 85%-98%). A direct comparison revealed no significant differences (p = 0.18-0.85) between the diagnostic performances of EP-POCUS (sensitivity: 81%, 95% CI: 61%-90%; specificity: 89%, 95% CI: 77%-95%) and RADUS (sensitivity: 74%, 95% CI: 65%-81%; specificity: 97%, 95% CI: 93%-98%). The meta-regression analyses revealed that study location, AA proportion, and mean age were sources of heterogeneity. Higher sensitivity and specificity tended to be associated with an appendix diameter cut-off value of 7 mm and the EP as the initial operator.

Conclusion: The diagnostic performances of EP-POCUS and RADUS were excellent for AA, with EP-POCUS having even better performance for pediatric AA. Accurate diagnoses may be achieved when the attending EP is the initial POCUS operator and uses a 7-mm cut-off value.

Keywords: Acute appendicitis; Emergency physician; Meta-analysis; Pediatric; Point-of-care ultrasonography.

Publication types

  • Meta-Analysis

MeSH terms

  • Acute Disease
  • Appendicitis / diagnostic imaging*
  • Appendix / pathology
  • Emergency Service, Hospital*
  • Humans
  • Point-of-Care Systems*
  • ROC Curve
  • Sensitivity and Specificity
  • Ultrasonography*