Test characteristics of emergency physician-performed point-of-care ultrasound for the diagnosis of intrauterine pregnancy: a systematic review and meta-analysis
Year: 2026
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: Point-of-care ultrasound (PoCUS) has emerged as a critical tool for diagnosing intrauterine pregnancy (IUP) in symptomatic first-trimester patients, particularly in emergency settings. This meta-analysis aims to evaluate the test characteristics of PoCUS in diagnosing IUP. As a secondary objective, this study will also examine the accuracy of PoCUS in detecting fetal cardiac activity (FCA). This systematic review and meta-analysis was conducted following the PRISMA-DTA guidelines with the protocol registered in PROSPERO (ID: CRD42024596206). We performed a comprehensive search of PubMed, Scopus, Web of Science, Cochrane Library and Google Scholar up to November 2024, identifying studies that compared PoCUS to reference standards for IUP diagnosis. Seven studies ( n = 1716) were included in the meta-analysis. Two independent reviewers performed study selection, data extraction, and quality assessment using the QUADAS-2 tool. A bivariate random-effects model was used to pool the diagnostic accuracy metrics. In this meta-analysis, PoCUS demonstrated a pooled sensitivity of 86.3% (95% CI: 75.6%–92.8%, I 2 = 89.8%) and a specificity of 98.2% (95% CI: 86.6%–99.8%, I 2 = 72.6%) for the identification of IUP. Sensitivity analysis showed a significant decrease in heterogeneity for specificity (from 72.6% to 0%), along with a slight increase in sensitivity (88.5%). The pooled positive likelihood ratio was 39.01 (95% CI: 16.00–95.1), and the negative likelihood ratio was 0.10 (95% CI: 0.05–0.21). Moreover, subgroup analysis revealed higher sensitivity (92%) in studies using transvaginal ultrasound as the reference standard. In addition, PoCUS demonstrated high specificity (100%) and variable sensitivity (81–96%) for identifying FCA across three studies, but the limited number of studies prevented further meta-analysis. PoCUS is highly effective for diagnosing IUP in symptomatic first-trimester patients, allowing for the ruling out of ectopic pregnancy. However, when PoCUS is negative or indeterminate, follow-up strategies such as serial β-hCG, repeat ultrasound, or clinical reassessment remain essential to ensure diagnostic safety.
Source: Internal and Emergency Medicine
Authors: Ali Çelik, Enes Hamdioğlu
Institution: Recep Tayyip Erdoğan University
Language: English
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $4,790
OpenAlex ID: W7124295694