Point-of-care ultrasound as a frontline tool for suspected acute aortic dissection: a systematic review and meta-analysis.

Background: Acute aortic dissection (AD) is a life-threatening cardiovascular emergency associated with high morbidity and mortality. Although computed tomography angiography (CTA) remains the reference diagnostic modality, rapid bedside assessment is often required in hemodynamically unstable patients. Point-of-care ultrasound (POCUS) has emerged as a potential adjunctive tool for early diagnosis and risk stratification. This systematic review and meta-analysis evaluated the diagnostic performance and clinical utility of POCUS in patients with suspected acute AD. Methods: A systematic review and meta-analysis were conducted in accordance with PRISMA 2020 guidelines. Ovid MEDLINE, PubMed, EMBASE, Scopus, and Web of Science were searched for studies published between January 2005 and January 2025. Studies evaluating the diagnostic accuracy of POCUS in adult patients with suspected AD were included. Two reviewers independently performed study selection, data extraction, and quality assessment using the QUADAS-2 tool. Pooled sensitivity, specificity, likelihood ratios, diagnostic odds ratios (DOR), and summary receiver operating characteristic (SROC) analyses were calculated. Results: Eleven studies met the inclusion criteria, and ten contributed data to the quantitative synthesis. The pooled analysis demonstrated an overall sensitivity of 0.86 [99% confidence interval (CI): 0.80-0.90] and specificity of 0.84 (99% CI: 0.78-0.89) for bedside ultrasound in the detection of acute AD. Diagnostic performance was more favourable for Stanford type A disease than for distal dissections. Visualization of an intimal flap was the most specific sonographic finding, whereas pericardial effusion, aortic root enlargement, and acute aortic regurgitation provided important complementary information for clinical assessment. Evidence from recent perspective cohorts further supports the incorporation of POCUS into structured diagnostic pathways for patients with suspected acute aortic syndromes (AAS). Conclusions: Bedside ultrasound represents a valuable component of the initial evaluation of suspected acute AD, particularly in emergency and critical care environments. Although confirmatory imaging remains mandatory for definitive diagnosis, POCUS can facilitate early recognition of AAS, support hemodynamic assessment, and help identify complications requiring urgent intervention.