Association of early point-of-care ultrasound with emergency department length of stay and safety in adults with abdominal pain: a propensity score–weighted study

Background and importance Nontraumatic abdominal pain is a common and challenging presentation in the emergency department (ED). Point-of-care ultrasound (PoCUS) offers rapid, bedside imaging, but its association with ED length of stay (LOS), resource use, and patient safety, particularly concerning unscheduled return visits, remains unclear. Objective To evaluate the association of early PoCUS (within 1 h) with ED LOS and safety in adults with nontraumatic abdominal pain. Design, settings, and participants A propensity score–weighted retrospective cohort analysis in a tertiary medical center in Taiwan (2021–2023). This study included 39 443 adult patients with nontraumatic abdominal pain (12 399 PoCUS < 1 h and 27 044 no PoCUS), excluding transfers. Intervention or exposure PoCUS performed by an emergency physician within 1 h of ED arrival. Outcomes measure and analysis Primary: ED LOS; secondary: ED costs, computed tomography (CT) use, outpatient disposition, and rate of admission after an unscheduled return visit. A key subanalysis evaluated outcomes (costs, hospital LOS, and mortality) for admissions after an unscheduled return visit. Analysis used inverse probability of treatment weighting-adjusted regression. Main result PoCUS performed within 1 h was associated with a 16% reduction in first ED LOS ratio of means 0.84, 95% confidence interval (CI): 0.83–0.86 and 50% increased odds of outpatient disposition odds ratio (OR): 1.50, 95% CI: 1.42–1.58. 1 st ED costs were slightly increased by 4% (ratio of means: 1.04, 95% CI: 1.03–1.06), and CT use was not reduced (OR: 0.98, 95% CI: 0.93–1.03). While associated with a 25% increased odds of admission after an unscheduled return visit (OR: 1.25, 95% CI: 1.02–1.53), this subgroup had 33% lower admission costs (ratio of means: 0.67, 95% CI: 0.57–0.80), 26% shorter hospital LOS (ratio of means: 0.74, 95% CI: 0.64–0.85), and 94% lower odds of ED death on return (ratio of means: 0.06, 95% CI: 0.01–0.54). Conclusion PoCUS performed within 1 h of ED arrival was associated with shorter ED LOS and more outpatient dispositions, without reducing CT use. However, it was also associated with an increased probability of admission following an unscheduled return visit. Future studies are needed to elucidate the causal impact of this practice on patient safety and downstream resource use.