A randomized prospective controlled trial was carried out comparing the value of immediate ultrasound examination with conventional management (selective ultrasound examination) in patients with acute abdominal symptoms. Immediate ultrasound led to earlier establishment of a final diagnosis but did not shorten the duration of in-patient care. Selective ultrasound improved diagnostic yield compared to immediate ultrasound and is believed to be the better option. It implies that a prompt but selective ultrasound service should be available for in-patients in the acute specialties.