Bedside ultrasound helps confirm child appendicitis
Bedside ultrasound in the emergency department was fairly accurate for diagnosing appendicitis in children, but a negative scan alone should not rule it out.
*Systematic review and meta-analysis of diagnostic studies; Level 1a.

Citation

Miller B, McCreary D, Rees J. How accurate is point-of-care ultrasound for detecting paediatric appendicitis? A systematic review and meta-analysis. Archives of Disease in Childhood. 2026;111:401–408. doi:10.1136/archdischild-2025-328953.

Background

Diagnosing appendicitis in children can be difficult, which can delay treatment or lead to unnecessary surgery. Bedside ultrasound performed by emergency clinicians could speed decisions and reduce radiation from advanced imaging.

Patients

Children and young adults (up to age 21) seen in paediatric emergency departments with suspected appendicitis. Studies were excluded if they were case series or did not provide diagnostic accuracy; many individual studies excluded very unstable patients or those with an already confirmed diagnosis.

Intervention

Bedside ultrasound performed by a non-radiologist clinician in the emergency department.

Control

Final diagnosis using surgical tissue results when available; otherwise clinical follow-up (varied by study).

Outcome

Diagnostic accuracy (primary); emergency department length of stay and use of computed tomography (secondary).

Follow-up Period

Varied: from hospital discharge to over 1 year (for non-surgical patients).

Results

Eight studies (993 patients) were included.
Outcome Estimate (95% confidence interval)
Sensitivity for appendicitis (primary) 85.6% (68.9% to 94.1%)
Specificity for appendicitis (primary) 90.2% (86.5% to 93.0%)
Sensitivity ranged from 53% to 100% across studies. Only one study assessed length of stay and reported shorter stays when bedside ultrasound was positive (154 minutes) versus needing radiology ultrasound or computed tomography (288–487 minutes). Two studies reported reduced computed tomography use after introducing bedside ultrasound pathways, but data were insufficient for firm conclusions.

Limitations

Studies were small and often used convenience samples. Training and scan criteria varied, and some follow-up methods could miss later appendicitis. Because sensitivity was not high enough, a negative bedside ultrasound may not be clinically reliable to exclude appendicitis without further evaluation.

Funding

No specific funding declared; no competing interests declared.

Clinical Application

Use bedside ultrasound to help confirm suspected paediatric appendicitis; do not use a negative scan alone to rule it out. Ensure operator training and follow local imaging pathways.