Comparison of quality and cost-effectiveness in the evaluation of symptomatic cholelithiasis with different approaches to ultrasound availability in the ED

Perception of point‐of‐care ultrasound performed by emergency medicine physicians

“…EM resident trainees are required to obtain extensive experience in a variety of POCUS applications prior to graduation in order to meet Accreditation Council for Graduate Medical Education requirements . The utility of EM‐POCUS is moving beyond a screening examination, toward a definitive diagnostic approach, with the potential to reduce time to disposition, increase resource and cost efficiency, and expedite management . Furthermore, EM‐POCUS offers consultant services the ability to avoid potential delays in timely management due to prolonged wait times for diagnostic imaging .…”

“…1,2 The application of EM-POCUS has been demonstrated to improve diagnostic efficiency and accuracy, to guide decision making, and to increase physician confidence. [4][5][6][7] EM resident trainees are required to obtain extensive experience in a variety of POCUS applications prior to graduation in order to meet Accreditation Council for Graduate Medical Education requirements. 3 The utility of EM-POCUS is moving beyond a screening examination, toward a definitive diagnostic approach, with the potential to reduce time to disposition, increase resource and cost efficiency, and expedite management.…”

Decreasing clinically significant adverse events using feedback to emergency physicians of telephone follow-up outcomes

“…1 The diagnosis is missed in up to 80% of patients who are later found to have acute cholecystitis, which significantly increases the complication rate. 2 For patients evaluated with chest pain, the diagnosis is missed in 5% of patients who are later diagnosed with acute myocardial infarction, which doubles mortality. 3,4 Emergency physicians fail to diagnose serious diseases for multiple reasons.…”

Clinical applications of bedside ultrasonography in internal and emergency medicine

“…2), as its sensitivity is higher than that of the CT scan. The test characteristics for gallstone detection by bedside US are: sensitivity 90-96%, specificity [1,11,12]. Presence of gallstones alone is not sufficient for a diagnosis of acute cholecystitis, but good positive predictive values can be achieved if secondary US findings such as a positive Murphy sign (focal tenderness during compression with the transducer over the gallbladder) or thickened gallbladder wall ([3 mm) are detected in conjunction with gallstones (positive predictive value, respectively, 92 and 95%) [13].…”