How accurate is point-of-care ultrasound for detecting paediatric appendicitis? A systematic review and meta-analysis.

Clinical Snapshot

Key Findings

• P Value: Not reported

• Effect Size: Pooled sensitivity 85.6%, pooled specificity 90.2%

• Primary Outcome: Diagnostic accuracy of POCUS for paediatric appendicitis

• Nnt Or Sensitivity: Sensitivity 85.6% (moderate), Specificity 90.2% (high) - positive likelihood ratio approximately 8.6, negative likelihood ratio approximately 0.16

• Confidence Interval: Sensitivity: 68.9%-94.1%, Specificity: 86.5%-93.0%

Clinical Application

POCUS is readily available in most Australian EDs, operator-dependent skill requirements may limit implementation Relevant to Australian paediatric EDs. May reduce CT radiation exposure in children, aligning with RANZCR imaging guidelines. Could support ACEM ultrasound competency requirements Children presenting to emergency departments with suspected appendicitis

Abstract

OBJECTIVES: Primary: To evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) in the diagnosis of appendicitis in paediatric patients presenting with suspected appendicitis.Secondary: To investigate how the use of POCUS affects length of stay in the paediatric emergency department and CT utilisation. METHODS: We searched MEDLINE, EMBASE and Cochrane Central Register of Controlled Trials (CENTRAL) up until February 2025 for studies involving patients presenting to the paediatric emergency department with suspected appendicitis, who underwent POCUS. Studies were assessed for risk of bias using the Quality Assessment Tool for Diagnostic Accuracy Studies framework. The primary outcome of interest was the ability of POCUS to detect appendicitis in terms of sensitivity and specificity. RESULTS: Eight studies were included encompassing 993 patients. Calculated pooled sensitivity was 85.6% (95% CI 68.9% to 94.1%) with a specificity of 90.2% (95% CI 86.5% to 93.0%). There was a wide range of reported sensitivities for POCUS, ranging from 53% to 100%. There was less variation in reported specificities that ranged from 82% to 95.2%. The studies analysed were of variable quality with the reference standard and flow and timing being the main areas subject to bias. CONCLUSIONS: Based on the findings of this systematic review and meta-analysis, it is reasonable to conclude that POCUS can be used as an effective tool to diagnose paediatric appendicitis. With a moderately high sensitivity, it may not be recommended to be used to exclude appendicitis based on POCUS findings alone. Further prospective studies evaluating the reliability of POCUS in excluding appendicitis, either alone or when combined with a clinical prediction rule, are required. Secondary findings from this study demonstrate that POCUS may result in a reduced length of stay in the paediatric emergency department and lead to a reduction in CT utilisation, though insufficient data were available to draw firm conclusions in relation to this.

References

1. 1.Miller, B., McCreary, D., & Rees, J. (2026). How accurate is point-of-care ultrasound for detecting paediatric appendicitis? A systematic review and meta-analysis. Archives of Disease in Childhood. https://doi.org/10.1136/archdischild-2025-328953