POCUS vs Computed Tomography in Acute Abdominal Pain: Acute Emergency Management and Clinical Outcomes

Point-of-care ultrasound and computed tomography play complementary roles in the evaluation of acute abdominal pain in emergency care. Point-of-care ultrasound offers the advantage of immediate bedside application, allowing the treating clinician to obtain rapid diagnostic information, accelerate clinical decision-making, and reduce the time to treatment. This approach is particularly valuable in hemodynamically unstable patients, trauma settings, and situations in which minimizing radiation exposure is important, such as in children and pregnant women. It has shown useful diagnostic performance in conditions such as small bowel obstruction and acute cholecystitis, and its use has been associated with shorter emergency department stays, fewer hospital admissions, and fewer unscheduled return visits. However, its diagnostic accuracy depends heavily on operator experience and may be limited in conditions requiring detailed anatomical visualization. Computed tomography remains the reference imaging method for many abdominal emergencies because it provides high sensitivity and specificity, broad anatomical assessment, and reliable identification of alternative diagnoses. It is especially important in suspected appendicitis, complicated bowel obstruction, perforation, mesenteric ischemia, intra-abdominal abscess, and traumatic injury, where precise anatomical definition is essential for diagnosis and procedural planning. Despite these advantages, computed tomography involves radiation exposure, higher cost, contrast-related risks, and potential delays caused by patient transport to the imaging suite. Overall, current evidence supports a complementary strategy in which point-of-care ultrasound serves as a first-line bedside tool for rapid assessment and risk stratification, while computed tomography is used for diagnostic confirmation and clarification when ultrasound findings are inconclusive or when greater anatomical detail is required. This combined approach can improve efficiency, optimize resource use, and support safe patient management in emergency settings.