Small bowel obstruction (SBO) remains a common indication for surgical consultation and potential surgical intervention in the Emergency Department (ED) [1]. Management decisions for patients presenting with SBO mostly rely on radiographic imaging in the ED [2]. Therefore, identifying the optimal use of imagings in patients with suspected SBO is essential. While computed tomography (CT) is widely used for diagnosing SBO due to its high sensitivity and specificity, it comes with drawbacks such as radiation exposure, increased costs, prolonged diagnostic time, and extended ED length of stay. In searching for an alternative imaging modality with high accuracy and real-time performance, point-of-care ultrasound (POCUS) has emerged as an initial, and potentially cost-saving imaging modality for patients with suspected SBO in ED [3].

As the use of POCUS for SBO increases, it is essential to understand how this modality performs across different subgroups of patients and clinicians. Multiple studies have investigated the diagnostic value of POCUS in patients with SBO [[3], [4], [5], [6]]. In most instances, these studies evaluated imaging performed by radiologists or performed on patients outside of the ED [[7], [8], [9], [10]]. In 2011, the first studies on the use of POCUS in SBO were published by Emergency Physicians (EPs) on ED patients [11,12]. Since then, several other ED-based POCUS studies to evaluate SBO have contributed to our understanding of this application [13,14]. However, these studies have reported variable diagnostic performance, and ultrasound's accuracy in the early detection of SBO remains a subject of debate [4]. For example, the accuracy of ultrasound for diagnosing SBO has varying reported sensitivity ranging from 70% to 100%, and the specificity ranging from 80% to 100% [[5], [6], [7]]. In addition, it is unclear in which patient subgroups POCUS performs best, as many of the prior studies were limited by variations in sonographers and patient characteristics. Therefore, there is a need to better understand POCUS accuracy by analyzing patient-level data within specific groups.

To further delineate the accuracy of POCUS for the diagnosis of SBO, we performed a meta-analysis utilizing individual patient-level participant data obtained from prospective studies examining POCUS for SBO in the ED.