The ABCDEFG point-of-care ultrasound protocol for acute non-traumatic abdominal pain: a prospective observational study.

Abstract

Objective: To evaluate whether the structured ABCDEFG point-of-care ultrasound protocol was associated with faster diagnostic resolution and improved emergency department efficiency in adults with acute non-traumatic abdominal pain.

Methods: We conducted a prospective single-centre observational cohort study in the emergency department of Baggiovara Hospital, Modena, Italy, between January and April 2025. Consecutive adults with acute non-traumatic abdominal pain were managed according to one of three provider-practice-based strategies: ABCDEFG POCUS, non-protocol POCUS, or standard care without bedside POCUS. The primary outcome was time to diagnosis.

Results: The analytic cohort included 218 patients: 66 in the ABCDEFG POCUS group, 70 in the non-protocol POCUS group, and 82 in the standard care group. Median time to diagnosis was shorter with ABCDEFG POCUS than with non-protocol POCUS or standard care: 91 min (IQR 59-134) versus 162 min (85-209) and 162 min (82-270), respectively (p < 0.001). ED processing time was 122, 180, and 206 min, respectively, and ED length of stay was 245, 314, and 325 min, respectively. CT use was 15.9%, 24.6%, and 32.9%, and plain abdominal radiography use was 12.3%, 26.1%, and 39.0%. Pathology-specific diagnoses were documented in 98.5%, 73.9%, and 75.6% of patients, respectively. Thirty-day revisits and mortality did not differ significantly across groups.

Conclusion: In this single-centre observational cohort, structured ABCDEFG POCUS was associated with faster diagnosis, shorter ED process times, lower selected imaging use, and fewer non-specific abdominal pain diagnoses. Multicentre studies are needed to assess reproducibility and patient-centred outcomes.