# Evaluating the Diagnostic Accuracy of Point-of-Care Ultrasound in Acute Abdominal Pain in the Emergency Setting

## TL;DR

This study shows that point-of-care ultrasound is highly accurate in diagnosing common causes of acute abdominal pain in emergency departments.

## Contribution

The study evaluates POCUS diagnostic accuracy for four common abdominal emergencies in a real-world emergency setting.

## Key findings

- POCUS correctly identified abdominal pathologies in 83.3% of cases.
- Diagnostic accuracy was over 92% for appendicitis, cholecystitis, bowel obstruction, and renal colic.
- Performance was consistent between male and female patients.

## Abstract

Introduction: Point-of-care ultrasound (POCUS) is increasingly recognized as a valuable diagnostic tool in emergency departments, particularly for evaluating non-traumatic acute abdominal pain. This study assessed the diagnostic accuracy of POCUS in identifying the most common causes of acute abdominal pain, i.e., appendicitis, cholecystitis, bowel obstruction, and renal colic, presenting in an emergency setting.

Methodology: This prospective observational study was conducted over 12 months at Mardan Medical Complex and District Headquarters (DHQ) Teaching Hospital, Gujranwala, Pakistan. A total of 180 adult patients (≥18 years) presenting with non-traumatic acute abdominal pain were enrolled using convenience sampling. POCUS was performed by trained emergency physicians in accordance with American College of Emergency Physicians (ACEP) guidelines. Final diagnoses were confirmed through radiological, surgical, or clinical outcomes. Data were analyzed using SPSS version 26.0 (IBM Corp., Armonk, NY). Statistical measures included sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), and diagnostic accuracy.

Results: The mean age of the patients was 39.5 ± 13.6 years (range: 18-80 years), with a slightly higher male predominance: 94 (52.2%) males and 86 (47.8%) females. The most common final diagnoses were appendicitis (44, 24.4%), renal colic (34, 18.9%), cholecystitis (30, 16.7%), and bowel obstruction (28, 15.6%). POCUS correctly identified the pathology in 150 (83.3%) cases. Condition-specific diagnostic accuracies were appendicitis at 92.2%, cholecystitis at 93.7%, bowel obstruction at 94.2%, and renal colic at 93.9%. Cases with nonspecific or unidentifiable abdominal pain were grouped under “Other” and not stratified further. Gender-based accuracy was comparable, with 79 (84.0%) correct diagnoses in males and 71 (82.6%) in females.

Conclusion: POCUS demonstrated high diagnostic accuracy for four of the most common abdominal emergencies, i.e., appendicitis, cholecystitis, bowel obstruction, and renal colic, and showed consistent performance across genders. While these findings support the role of POCUS as a valuable tool in emergency settings, particularly in resource-constrained environments, they should be interpreted within the study’s scope. Broader generalization to all causes of abdominal pain requires further research with larger, more diverse patient populations and long-term follow-up.