Diagnostic Accuracy of Point-of-Care Ultrasound in Detecting Pneumothorax: A Systematic Review and Meta-Analysis

Abstract

Point-of-care ultrasound (POCUS) is increasingly used in emergency departments for the rapid detection of pneumothorax. While POCUS offers bedside convenience, its diagnostic accuracy compared with standard imaging remains variable, necessitating an updated synthesis of evidence. We conducted a systematic review and meta-analysis following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses for Diagnostic Test Accuracy (PRISMA-DTA) guidelines. Databases including PubMed, Scopus, Web of Science, and Google Scholar were searched for studies evaluating POCUS for pneumothorax detection in emergency settings. Data on sensitivity, specificity, and operator characteristics were extracted. Study quality was assessed using the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2), and a bivariate random-effects model was used to pool diagnostic accuracy metrics. Subgroup and sensitivity analyses explored sources of heterogeneity. Fifteen studies comprising 3,840 patients were included. Pooled sensitivity of POCUS for detecting pneumothorax was 74.3% (95% CI: 55.4-87.4%), and pooled specificity was 99.1% (95% CI: 98.5-99.9%). Diagnostic odds ratio was 104.4 (95% CI: 93.0-112.8), with positive and negative likelihood ratios of 15.1 (95% CI: 5.66-40.38) and 0.028 (95% CI: 0.008-0.095), respectively. Subgroup analyses showed higher sensitivity for prospective studies, non-trauma patients, the two-point ultrasound protocol, and operators with greater training and experience, while specificity remained consistently high across all subgroups. No significant publication bias was detected. POCUS is a highly specific and moderately sensitive tool for the rapid detection of pneumothorax in emergency settings. Diagnostic performance improves with standardized protocols and experienced operators. Despite some variability in sensitivity, POCUS can reliably identify pneumothorax and reduce unnecessary thoracic interventions.