Point-of-Care Ultrasound reduces Emergency Department Length of Stay in Patients with Acute Appendicitis

Background: Acute appendicitis (AA) is a common surgical emergency where timely diagnosis is eminent. Point-of-care ultrasound (POCUS) offers a fast, bedside imaging option that may reduce emergency department (ED) length of stay (LOS), though the diagnostic accuracy is highly examiner-dependent. This study evaluated the effect of POCUS performed by emergency physicians on ED LOS in patients with suspected AA at a tertiary hospital in Lucerne, Switzerland. Methods: We conducted a retrospective monocentric study including patients who presented to the ED in 2022–2023 and subsequently underwent an appendectomy for AA. Patients were divided into four subgroups based on imaging modality and examiner. Results: 252 patients met the inclusion criteria. Group distributions were as follows: Group 1 (US by ED): 107; Group 2 (US by ED + radiology or only by radiology): 59; Group 3 (US + CT): 60; Group 4 (CT only): 26. A statistically significant difference in LOS was observed among groups, particularly favouring POCUS by ED physicians (p < 0.001). In group 3, CT was performed to confirm strong US suspicion (41.7%), non-visualisation (40%), inconclusive findings (15%), or other differentials (3.3%); among cases with strong US suspicion, perforation was queried in 60%. Ultrasound experience, reflected by the weighted average, increased over time, accompanied by a rise in US-only diagnoses in the ED. Multivariable linear regression identified younger age, lower BMI, and lower CRP as significant predictors of diagnosis based on ultrasound alone (p < 0.001), R² = 0.373. Conclusions: Patients with AA diagnosed by emergency physician-performed POCUS had a significantly shorter ED LOS. Increasing ultrasound competency among emergency physicians was paralleled by a proportional increase in cases diagnosed exclusively by US in the ED. The likelihood of requiring CT imaging increased with higher patient age, BMI and CRP.