Schneider, C., Frei, N., Fernandez, A. Frei, C., Wahedi, K., Husarek, J., Karrer, T., Aubert, C.E., Lehmann, B., Müller, M.
Diagnostic accuracy of point-of-care ultrasound in adult non-traumatic emergency medicine: an umbrella review.
BMC Med (2026). https://doi.org/10.1186/s12916-026-05094-2
Background
Point-of-care ultrasound (POCUS) has become an increasingly used diagnostic tool in adult emergency departments (ED). Although numerous diagnostic test accuracy systematic reviews (DTA-SR) evaluating various POCUS applications 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 adult non-traumatic emergency medicine-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 from database inception to April 2026 for DTA-SR with meta-analysis evaluating the diagnostic performance of POCUS in adult ED populations for non-traumatic emergency medicine-relevant conditions. DTA-SR were included if they reported pooled sensitivity and specificity against accepted reference standards. The methodological quality was assessed using a DTA-adapted AMSTAR 2 tool. Sensitivity and specificity estimates were graded using the GRADE approach. Results were synthesized using a predefined hierarchical decision framework to account for overlap between primary studies.
Results
A total of 197 DTA-SR were included, most focusing on cardiovascular, gastrointestinal, respiratory, or musculoskeletal conditions. About half were conducted in ED; the rest examined emergency medicine-relevant conditions in specialist settings. Methodological quality was mostly low or moderate. Diagnostic utility varied substantially across conditions. Among 91 evaluated conditions, 12 fulfilled predefined criteria for combined rule-in/rule-out supportive applications, 17 for primarily rule-in supportive applications, and 6 for primarily rule-out supportive applications (defined as pooled sensitivity or specificity ≥ 90% with at least moderate certainty of evidence). The remaining conditions were categorized as adjunctive because these thresholds were not met. Overall, certainty of evidence was frequently low or very low.
Conclusions
POCUS shows promising diagnostic accuracy across adult non-traumatic emergency medicine-relevant conditions, often with moderate to high sensitivity and very high specificity. However, the overall strength and consistency of the evidence are limited. Therefore, diagnostic performance estimates should be interpreted with caution and within the context of each specific clinical condition, and should not be considered directly comparable or additive across different indications. Further high-quality research is needed to better define its role in emergency care.
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