Abstract
INTRODUCTION: Children with hip pain, limp and inability to bear weight often present a diagnostic clinical challenge. Sonography is an ideal first-line imaging modality to assess for effusion, and recent literature suggests that point-of-care ultrasound (POCUS) performed by emergency providers can be safely and accurately performed at the bedside. This systematic review and meta-analysis aims to summarize the diagnostic accuracy of POCUS for pediatric hip effusion.
METHODS: MEDLINE, Embase, Web of Science, CINAHL, and Cochrane Central databases were searched through July 2025, with no date limits, using pre-defined criteria for articles assessing the diagnostic accuracy of POCUS for pediatric hip effusion. Data were extracted and quality assessment was performed using the QUADAS-2 tool. Test characteristics were pooled using a bivariate mixed effects model for meta-analysis.
RESULTS: Four studies, with a total of 526 hips scanned, met our inclusion criteria. The reference standard for all included studies was radiology-performed ultrasonography. POCUS demonstrated a pooled sensitivity of 88% (95% CI, 82%-92%), specificity of 97% (95% CI, 93%-99%), positive likelihood ratio of 35 (95% CI, 12.0-100.8), and negative likelihood ratio of 0.13 (0.08-0.19).
CONCLUSIONS: POCUS has high specificity and moderate sensitivity for hip effusion in children and is a valuable first-line diagnostic tool for evaluating children with hip pain, limp and inability to bear weight in emergency and acute care settings.