Point of Care Ultrasound in the Emergency Department: An Umbrella Review of Systematic Reviews of Diagnostic Test Accuracy

Background Point-of-care ultrasound (POCUS) has become an increasingly diagnostic tool in the overcrowded emergency department (ED). Although numerous diagnostic test accuracy systematic reviews (DTA-SRs) on various conditions evaluating POCUS are available, clinicians often face uncertainty due to ungraded accuracy estimates and inconsistent evidence.

We conducted an umbrella review to i) summarize diagnostic accuracy evidence for POCUS across various emergency-relevant conditions, ii) provide GRADE-based ratings of pooled sensitivity and specificity, and iii) synthesize findings when multiple DTA-SR addressed the same condition.

Methods We systematically searched PubMed and Embase for DTA-SR with meta-analysis evaluating the diagnostic performance of POCUS in adult ED populations. Reviews were included if they reported pooled sensitivity and specificity against accepted reference standards. The methodological quality was assessed using an adapted AMSTAR-2 tool. Sensitivity and specificity estimates were graded using the GRADE approach. Conditions were categorized into 10 domains; results were synthesized narratively due to overlap between primary studies.

Results A total of 172 POCUS DTA-SRs were included, most focusing on trauma (n=37), cardiovascular (36), gastrointestinal (24), respiratory (20), and musculoskeletal (15) conditions. About half were conducted in emergency settings; the rest examined emergency-relevant conditions in specialist settings. Methodological quality was mostly rated low or moderate. While ultrasound generally showed at least moderate sensitivity and often very high specificity, the certainty of evidence was frequently very low to low with oftentimes high heterogeneity ([Fig. 1]).

Fig. 1  Overview of selected conditions in the different included domains of all identified POCUS diagnostic test accuracy systematic review with meta-analysis

Conclusion POCUS shows promising diagnostic accuracy across a wide range of emergency-relevant conditions. However, the underlying evidence is often of limited quality, highlighting the need for higher-quality primary research and systematic reviews.