The impact of point-of-care ultrasound in the timely management of emergency department patients with complications of first-trimester pregnancy: a systematic review and meta-analysis.

AIM: To ascertain the potential value of pelvic point-of-care ultrasound (POCUS) in the timely management of Emergency Department (ED) patients presenting with first trimester pregnancy complications.

OBJECTIVES

To perform a systematic review and meta-analysis with the primary outcome being the comparison of ED length of stay (ED LoS), time to ultrasound (US) diagnosis and time to operative room (OR) treatment in patients under 20 weeks gestation with complications of first trimester pregnancy when comparing POCUS to traditional specialist radiology ultrasound (RADUS).

METHOD: In accordance with PRISMA guidelines we performed a literature search based on specific inclusion criteria and used 2 reviewers to screen appropriate studies for inclusion. Papers were then critically appraised using RoB-2 and ROBINS-I assessment tools before having data extracted for inclusion in meta-analysis where possible.

RESULTS

We identified 13 papers for inclusion in systematic review which measured a single or multiple outcome measures. 10 papers addressed the ED LOS outcome, 5 studied time to ultrasound diagnosis and 4 measured time to operative treatment. Of those studies, 6 contained sufficient data to be included in meta-analysis for ED LoS and 3 could be pooled for time to US diagnosis outcome. Insufficient usable studies were identified for time to OR treatment meta-analysis. The POCUS group had a reduced ED LoS of 59.6 min (95% CI 23.6-95.5, P = 0.008) when compared to RADUS. The POCUS group also had a reduced time to US diagnosis of 81.8 min (95%CI 32.2-195.9, P = 0.09). Whilst all time to OR studies reported time savings in this area, no reliable conclusions could be drawn due to insufficient paper numbers and reported data. For all outcomes there was substantial heterogeneity between the studies relating to differing institutional workflows, measured timestamps, triage bias and range of disease severity. Almost all included studies were felt to be at serious risk of bias.

CONCLUSION

Whilst the use of POCUS shows promise in improving efficiency of care for ED patients presenting with early pregnancy complications, there are significant concerns regarding the heterogeneity and generalisability of the study data. European EDs need to explore this POCUS modality more with large scale RCTs, including clearly defined patient cohorts and POCUS protocols, to reliably confirm causality of patient benefit in this area.