A Prospective Evaluation of Emergency Department Bedside Ultrasonography for the Detection of Acute Cholecystitis

Abstract

Study objective: We assess the diagnostic accuracy of emergency physician-performed bedside ultrasonography and radiology ultrasonography for the detection of cholecystitis, as determined by surgical pathology. Methods:We conducted a prospective, observational study on a convenience sample of emergency department (ED) patients presenting with suspected cholecystitis from May 2006 to February 2008. Bedside gallbladder ultrasonography was performed by emergency medicine residents and attending physicians at an academic institution. Emergency physicians assessed for gallstones, a sonographic Murphy's sign, gallbladder wall thickness, and pericholecystic fluid, and the findings were recorded before formal imaging. The test characteristics of bedside and radiology ultrasonography were determined by comparing their respective results to pathology reports and clinical follow-up at 2 weeks.Results: Of the 193 patients enrolled, 189 were evaluated by bedside ultrasonography. Forty-three emergency physicians conducted the ultrasonography, and each physician performed a median of 2 tests. After the bedside ultrasonography, 125 patients received additional radiology ultrasonography. Twenty-six patients underwent cholecystectomy, 23 had pathology-confirmed cholecystitis, and 163 were discharged home to follow-up. Twenty-five were excluded (23 lost to follow-up and 2 unavailable pathology). The test characteristics of bedside ultrasonography were sensitivity 87% (95% confidence interval [CI] 66% to 97%), specificity 82% (95% CI 74% to 88%), positive likelihood ratio 4.7 (95% CI 3.2 to 6.9), negative likelihood ratio 0.16 (95% CI 0.06 to 0.46), positive predictive value 44% (95% CI 29% to 59%), and negative predictive value 97% (95% CI 93% to 99%). The test characteristics of radiology ultrasonography were sensitivity 83% (95% CI 61% to 95%), specificity 86% (95% CI 77% to 92%), positive likelihood ratio 5.7 (95% CI 3.3 to 9.8), negative likelihood ratio 0.20 (95% CI 0.08 to 0.50), positive predictive value 59% (95% CI 41% to 76%), and negative predictive value 95% (95% CI 88% to 99%). Conclusion:The test characteristics of emergency physician-performed bedside ultrasonography for the detection of acute cholecystitis are similar to the test characteristics of radiology ultrasonography. Patients with a negative ED bedside ultrasonography result are unlikely to require cholecystectomy or admission for cholecystitis within 2 weeks of their initial presentation.

Diagnosis ofacute cholecystitis using ultrasonography

“…There are also studies proving the accuracy and advantages of US performed in emergency as compared to hepato- [22,23] or computer tomography [24] .Summers and Colab. studied a better accuracy of US performed in the emergency setting than that of the same method performed by radiologists for the identificationof surgical conditions such as acute cholecystitis [25] .The originality of the study resides in the correlation of the clinical and ultrasonographic aspects with intra-operatory findings, as well as in the analysis of sonographicrole in the diagnosis of different forms of cholecystitis.The incidence of acute cholecystitis was higher in female patients,andmost of the patient who complain of acute calculuscholecystitis created at age between (41-50) years old, The results of the present study confirm the variations in lithiasis incidence, as stated in the epidemiological literature [26,27] . We also found an increased incidence of the disease in patients from an urban areas, revealed that most of Khartoum population complain a lot from (ACC) ,represent71% ,comparewith Kassala and Omdurman.…”

Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review

“…11 EPs have become more adept at fracture diagnosis through independent review of US and radiographic imaging, and many researchers have examined the ability of EPs to obtain US imaging and diagnose fracture. 12,13 Additionally, bedside US has excellent diagnostic test characteristics when performed by EPs compared to radiologists in the diagnostic evaluation for soft tissue infections, 14 cholecystitis, 15 pneumothorax, 16 or ruling out ectopic pregnancy.…”

Sepsis due to pyonephrosis: an adult with pelvic–ureteric junction obstruction (PUJO) in a duplex kidney

“…Ultrasound can be helpful in identifying the source of infection [8][9][10][11]; it can help define and monitor the hemodynamic status of the patient via evaluation of inferior vena cava, heart and lung water [12][13][14]; it can guide invasive procedures in both diagnosis (sampling) and treatment (drainage) [15].…”