Diagnostic accuracy of point-of-care ultrasound for diverticulitis: a systematic review and meta-analysis

BACKGROUND: Diverticulitis is a common emergency department (ED) diagnosis requiring imaging for confirmation. Point-of-care ultrasound (PoCUS) has emerged as a rapid and accessible modality for evaluating acute abdominal conditions. This systematic review and meta-analysis aimed to assess the diagnostic accuracy of PoCUS in detecting acute diverticulitis. As a secondary objective, we evaluated its accuracy in diagnosing complicated diverticulitis. METHODS: We performed a systematic review and meta-analysis in accordance with PRISMA-DTA guidelines. MEDLINE, Scopus, Web of Science, and CENTRAL were searched through February 2025, and risk of bias was assessed using QUADAS-2. The reference standard was computed tomography (CT) with or without intravenous contrast or comprehensive clinical follow-up. A bivariate random-effects model was used for pooled estimates. RESULTS: Six studies (n = 1,420) evaluating PoCUS performed by emergency physicians or other non-radiologist clinicians were included. Pooled sensitivity and specificity of PoCUS for acute diverticulitis were 94% (95% CI: 92–95%) and 86% (95% CI: 72–94%), respectively. Emergency physician-performed PoCUS showed improved specificity (91%, 95% CI: 88–94%) with similar sensitivity (94%, 95% CI: 91–95%). For complicated diverticulitis, PoCUS demonstrated high specificity (98%, 95% CI: 97–99%) but moderate sensitivity (58%, 95% CI: 46–69%). CONCLUSION: PoCUS is a highly effective diagnostic tool for diverticulitis, offering high sensitivity and specificity. It serves as a practical first-line imaging modality and may reduce reliance on CT imaging. However, due to its moderate sensitivity for complications, confirmatory imaging such as CT is recommended when complications are suspected. TRIAL REGISTRATION: PROSPERO (CRD42025648563).