Impact of Emergency Department Point-of-Care Ultrasound on the Emergency Department Length of Stay and Time to Diagnosis in Early Pregnancy: A Systematic Review and Meta-Analysis

BACKGROUND: Early pregnancy complications represent a substantial reason for emergency department (ED) visits, with ectopic pregnancy remaining a significant cause of maternal mortality. OBJECTIVES: This systematic review and meta-analysis aim to evaluate the effectiveness of ED point-of-care ultrasound (POCUS) vs. standard radiology- or obstetric-performed ultrasound (US) for early pregnancy assessment in emergency settings. METHODS: Four databases were systematically searched for studies including patients with early pregnancy (<20 weeks of gestation) presenting to the ED. Differences in ED length of stay (LOS), time to diagnosis, time to surgery for patients with ectopic pregnancy, and the rate of missed ectopic cases were analyzed. Weighted mean differences (WMDs) and risk ratios (RRs) with 95% confidence intervals (CIs) were calculated. The study was registered in the International Prospective Register of Systematic Reviews database (ID CRD420251242734). RESULTS: Thirteen studies with 4057 early pregnancy patients (ED POCUS = 1848 and standard US = 2209) were included. Compared with standard imaging, ED POCUS was associated with statistically significant reductions in ED LOS (WMD -59.53, 95% CI -77.43 to -41.62, p < 0.00001) and time to definitive diagnosis (WMD -80.93, 95% CI -119.10 to -42.77, p < 0.0001). Moreover, pooled analysis reported no statistically significant difference in the rate of missed ectopic cases between ED POCUS and standard US (RR 1.22, 95% CI 0.39-3.87, p = 0.73). CONCLUSION: ED POCUS is associated with measurable improvements in emergency care efficiency without a statistically significant increase in missed diagnoses of ectopic pregnancy. Future high-quality, multicenter randomized studies are needed to better define the diagnostic accuracy, safety, and generalizability of ED POCUS in early pregnancy evaluation.