Research Appraisals
Evidence-based critical appraisals of the latest medical research, systematically evaluated using Oxford CEBM methodology.
Showing 4 appraisals
Archives of disease in childhood
How accurate is point-of-care ultrasound for detecting paediatric appendicitis? A systematic review and meta-analysis.
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.
19 Apr 2026
Read appraisal →Journal of neurology
Accuracy of muscle ultrasonography in detecting fasciculations for the diagnosis of amyotrophic lateral sclerosis: a systematic review and meta-analysis
PURPOSE: This systematic review and meta-analysis aims to evaluate the diagnostic accuracy of muscle ultrasonography in detecting fasciculations for the diagnosis of amyotrophic lateral sclerosis (ALS). METHODS: Following PRISMA-DTA guidelines, we systematically searched PubMed, Embase, Cochrane Library, Ovid Medline, Sinomed, Web of Science, CNKI and VIP for studies published up to July 8, 2025 that evaluated muscle ultrasonography to detect fasciculations for ALS diagnosis. The study protocol was registered in PROSPERO (CRD420251057866). Studies were screened using predefined inclusion and exclusion criteria and data were extracted. Risk of bias was assessed with QUADAS-2. Statistical analyses (Stata 16.0 and R 4.5.1 with the "midas," "metandi," and "mada" packages) were used to calculate pooled sensitivity (Sen), specificity (Spe), positive likelihood ratio (LR+), negative likelihood ratio (LR-), and diagnostic odds ratio (DOR). We constructed forest plots, hierarchical summary receiver operating characteristic (HSROC) curves, summary ROC (SROC) curves and calculated the area under the SROC curve (AUC). Univariate meta-regression and subgroup analyses explored sources of heterogeneity. Publication bias was assessed using Deeks' funnel plot asymmetry test. Fagan nomograms were also used to illustrate the changes from pre-test to post-test probability and to enhance clinical interpretability. RESULTS: Thirteen studies involving 1176 participants met the inclusion criteria. Muscle ultrasonography for fasciculation detection in ALS yielded a pooled sensitivity of 0.87 (95% CI 0.83-0.91) and specificity of 0.91 (95% CI 0.86-0.94). The pooled LR+ was 9.81 (95% CI 6.25-15.40) and LR- was 0.14 (95% CI 0.10-0.19), with a DOR of 70.03 (95% CI 41.72-117.56). The area under the SROC curve was 0.94 (95% CI 0.91-0.95). Meta-regression identified scan duration as a primary factor influencing diagnostic accuracy, with scan durations ≥ 30 s associated with higher sensitivity but relatively lower specificity. Deeks' funnel plot showed no significant asymmetry (p = 0.61), indicating no notable publication bias. Fagan nomograms showed that, at a pre-test probability of 30%, the post-test probability increased to 81% after a positive MUS result and decreased to 6% after a negative result. CONCLUSION: Muscle ultrasonography demonstrates good pooled diagnostic accuracy for detecting fasciculations in ALS and may serve as a useful adjunct to electrodiagnostic evaluation. Scan duration appears to significantly affect the diagnostic performance, with longer scanning improving sensitivity at the cost of reduced specificity. We speculate that prolonged scanning may be more useful in clinical scenarios where fasciculations are subtle or atypical, whereas shorter scanning may be sufficient when fasciculations are already readily apparent. Nevertheless, further large-scale prospective studies are needed to validate standardized scanning protocols and to better define the clinical role of MUS in ALS diagnostic pathways.
7 Apr 2026
Read appraisal →Journal of special operations medicine : a peer reviewed journal for SOF medical professionals
AI-Assisted Lung Sliding Detection in Point-of-Care Ultrasound by Marine Corps Corpsmen: A Multi-Reader Study
BACKGROUND: Artificial intelligence (AI) has the potential to address training limitations and inter-operator variability that constrain the use of lung ultrasound (LUS) in austere and prehospital settings. This pilot study evaluated whether AI-based decision support could improve the diagnostic accuracy and confidence of United States Marine Corps Corpsmen in identifying absent lung sliding, a key indicator of pneumothorax, during LUS interpretation. METHODS: This pilot-prospective multi-reader, multi-case study involved five military medics, all novices in point-of-care ultrasound, each interpreting 50 de-identified LUS video clips twice, once without AI assistance (control) and once with AI assistance (ATLAS, Deep Breathe Inc., London, Canada), in randomized order with at least a 2-hour washout between sessions. Expert consensus served as a reference standard. Diagnostic performance was assessed using area under the receiver operating characteristic curve (AUROC), sensitivity, specificity, and accuracy. Differences were analyzed using the Random-Reader Random-Case method. Per-clip reader confidence ratings were compared using the Stuart-Maxwell test. RESULTS: AI assistance significantly improved diagnostic performance across all measured outcomes. The mean AUROC increased from 0.72 (SD 0.16) without AI to 0.93 (SD 0.04) with AI (P=.03). Sensitivity rose from 0.63 (SD 0.14) to 0.90 (SD 0.09), specificity from 0.70 (SD 0.15) to 0.86 (SD 0.10), and overall accuracy from 0.67 (SD 0.10) to 0.88 (0.06) (McNemar's test, P<.001). Reader confidence also improved, with high-confidence ratings nearly doubling from 20% to 37%, and low-confidence ratings decreasing from 38% to 33%. These distributional changes were statistically significant (Stuart-Maxwell χ², P<.001). CONCLUSION: AI support markedly improved the diagnostic accuracy and confidence of novice LUS interpretation for detecting absent lung sliding. These findings suggest that real-time AI-based decision support may help improve access to high-quality LUS in military and other resource-limited care settings.
5 Apr 2026
Read appraisal →Journal of neurology
Sonographic optic nerve sheath diameter measurement for detecting intracranial hypertension in a suspected population: a systematic review and meta-analysis of diagnostic thresholds and influencing factors
OBJECTIVES: In this study, we aimed to assess the clinical efficacy of sonographic optic nerve sheath diameter (ONSD) measurements for detecting intracranial hypertension (ICH). Our objectives included evaluating its diagnostic precision compared with invasive intracranial pressure (ICP) monitoring; exploring potential sources of heterogeneity, such as measurement technique (multi vs. single-planar), population demographics (Asian vs. non-Asian), and major etiologies; and determining validated thresholds for prompt bedside ICP assessment in acute neurological crises. DATA SOURCES: We comprehensively searched eight databases, including four in English (PubMed, Web of Science, MEDLINE®, and Embase) and four in Chinese (China National Knowledge Infrastructure [CNKI], Wanfang, VIP, and SinoMed). The search covered literature published from the inception of the databases up to May 31, 2025. STUDY SELECTION: This review includes prospective, retrospective, and case-control studies that assess the efficacy of sonographic ONSD measurement for detecting ICH, defined as an ICP exceeding 20 mm Hg, 20 cmH2O, 25 cmH2O with invasive ICP measurement as the gold standard. DATA EXTRACTION: X.T. and Q.T. independently screened the studies and assessed the risk of bias using the QUADAS-2 tool. STATISTICAL ANALYSIS: Diagnostic accuracy was pooled using a bivariate random-effects model to generate summary receiver operating characteristic (SROC) curves. Subgroup analyses of the measurement technique, study population, and etiology were conducted. Publication bias was assessed using Deeks' test. DATA SYNTHESIS: The decision tree analysis revealed that an ONSD ≥ 5.1 mm is the critical diagnostic threshold for detecting intracranial hypertension. The regression tree model indicated a range of CDEI values from 0.64 to 0.95, with a root node value of 0.82 (95% CI: 0.79-0.85). The incorporation of a multiplanar assessment significantly enhanced the prediction of favorable outcomes (CDEI > 0.85; p < 0.001). Moreover, compared with a 20 mmHg threshold, a 25 cmH₂O threshold resulted in greater specificity (88.4% vs. 82.9%) and a higher positive likelihood ratio (LR+ 6.5 vs. 5.0). The utilization of multiplane techniques and experienced operators notably improved diagnostic accuracy, leading to a 50% reduction in missed diagnoses (LR- 0.1). Nontraumatic brain injury cases exhibited superior sensitivity (91.9% vs. 85.2%) and a 107% higher diagnostic odds ratio (63.3 vs. 30.5) than traumatic brain injury cases did. CONCLUSIONS: Findings from this study suggest that an ONSD threshold ≥ 5.1 mm is a promising diagnostic marker for elevated ICP (> 20 cmH₂O/mmHg or acute etiology), although external validation is needed. A multiplane evaluation improves its predictive accuracy for favorable outcomes. The developed decision model supports the use of sonographic ONSD measurement as a supplementary screening tool in emergency and critical care, particularly when invasive monitoring is unavailable. Additionally, an ONSD of approximately 6.0 mm is a potential prognostic indicator for unfavorable outcomes, highlighting a key area for future research. These findings can only be applied after their validation through multicenter studies and the establishment of standardized measurement protocols.
4 Apr 2026
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