Diagnostic Accuracy of Point-of-Care Gastric Ultrasound

Kruisselbrink, Richelle; Gharapetian, Angineh; Chaparro, Luis Enrique; Ami, Noam; Richler, Dustin; Chan, Vincent; Perlas, Anahi

doi:10.1213/ane.0000000000003372

Cited by 91 publications

(73 citation statements)

References 38 publications

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“…Gastric ultrasound should be viewed as an adjunctive tool to increase the margin of safety when performing anaesthetic interventions, with high sensitivity (1.0), specificity (0.975), positive predictive value (0.976), and negative predictive value (1.0) in the presence of clinical equipoise. 15 Inexperienced point-of-care gastric sonographers have been found to require 33 supervised scans to achieve a 95% accuracy in qualitative assessment of gastric content. 16 In conjunction with considering the urgency of surgery, medical factors, and alternative options for anaesthesia, gastric ultrasound has been shown to lead to changes in anaesthetic management.…”

Section: Implications For Clinical Practicementioning

confidence: 99%

Perioperative point-of-care gastric ultrasound

2019

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By reading this article you should be able to:Explain the indications and limitations of pointof-care gastric ultrasound. Describe the acquisition and interpretation of images for qualitative and quantitative analysis of gastric content for the purposes of pulmonary aspiration risk stratification. Discuss the role of gastric ultrasound in the management of obese, pregnant, and paediatric patients.

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Section: Implications For Clinical Practicementioning

confidence: 99%

Perioperative point-of-care gastric ultrasound

2019

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“…Kruisselbrink et al 17 assessed the diagnostic accuracy of point-of-care gastric ultrasound to detect a “full stomach” (defined as either solid particulate content or >1.5 mL/kg of fluid) in 40 healthy volunteers. The authors reported an LR+ of 40.0 (95% confidence interval [CI], 10.3–∞) and an LR− of 0 (95% CI, 0–0.07), indicating that gastric ultrasound is highly accurate to rule in and to rule out a full stomach.…”

Section: Likelihood Ratiomentioning

confidence: 99%

“…Assuming a pretest probability of 50% for having a full stomach (the prevalence in their study sample), the authors used a nomogram to show that a positive test result increases the probability of having a full stomach to 97%, whereas a negative test result decreases the probability to <.1%. 17 …”

Section: Likelihood Ratiomentioning

confidence: 99%

Diagnostic Testing and Decision-Making: Beauty Is Not Just in the Eye of the Beholder

Vetter

Schober

Mascha³

2018

Anesthesia &Amp; Analgesia

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To use a diagnostic test effectively and consistently in their practice, clinicians need to know how well the test distinguishes between those patients who have the suspected acute or chronic disease and those patients who do not. Clinicians are equally interested and usually more concerned whether, based on the results of a screening test, a given patient actually: (1) does or does not have the suspected disease; or (2) will or will not subsequently experience the adverse event or outcome. Medical tests that are performed to screen for a risk factor, diagnose a disease, or to estimate a patient’s prognosis are frequently a key component of a clinical research study. Like therapeutic interventions, medical tests require proper analysis and demonstrated efficacy before being incorporated into routine clinical practice. This basic statistical tutorial, thus, discusses the fundamental concepts and techniques related to diagnostic testing and medical decision-making, including sensitivity and specificity, positive predictive value and negative predictive value, positive and negative likelihood ratio, receiver operating characteristic curve, diagnostic accuracy, choosing a best cut-point for a continuous variable biomarker, comparing methods on diagnostic accuracy, and design of a diagnostic accuracy study.

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“…In this study, no useful images could be obtained in three subjects, and an additional five patients could not be unambiguously assigned to a Perlas category (Figure ). Also, a small amount of baseline air in the antrum may resemble solid content and lead to a false‐positive identification of solid content . While antral CSA can be measured with high intra‐ and inter‐rater reliability, the estimation of gastric volume based on available prediction equations introduces some degree of variability.…”

Section: Limitationsmentioning

confidence: 99%

“Full Stomach” Despite the Wait: Point‐of‐care Gastric Ultrasound at the Time of Procedural Sedation in the Pediatric Emergency Department

Leviter

Steele

Constantine

et al. 2018

Academic Emergency Medicine

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Objectives:The objective was to use gastric point-of-care ultrasound (POCUS) to assess gastric contents and volume, summarize the prevalence of "full stomach," and explore the relationship between fasting time and gastric contents at the time of procedural sedation.Methods: This was a prospective study of patients aged 2 to 17 years fasting prior to procedural sedation. A single sonographer scanned each patient's gastric antrum in two positions: supine with the upper body elevated and right lateral decubitus (RLD). Gastric content (empty, liquid, or solid) was noted, and the gastric volume (mL/ kg) was estimated from antral cross-sectional area (CSA). "Full stomach" was defined as any solid content or >1.2 mL/kg of liquid gastric content.Results: We enrolled 116 subjects, with a median fasting time of 5.8 hours. Of the 107 with evaluable images, 74 patients, 69% (95% confidence interval [CI] = 60%-77%), were categorized as having a full stomach. Each hour of fasting was associated with lower odds (odds ratio = 0.79, 95% CI = 0.65-0) of a full stomach. However, the knowledge of fasting time alone provides little ability to discriminate between risk groups (C-index = 0.66).Conclusions: Gastric POCUS classified many patients as having a full stomach at the time of expected procedural sedation, despite prolonged fasting times. These findings may inform risk-benefit considerations when planning the timing and medication choice for procedural sedation.

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Diagnostic Accuracy of Point-of-Care Gastric Ultrasound

Abstract: Our results suggest that bedside gastric ultrasound is highly sensitive and specific to detect or rule out a full stomach in clinical scenarios in which the presence of gastric content is uncertain.

Cited by 91 publications

References 38 publications

Perioperative point-of-care gastric ultrasound

Perioperative point-of-care gastric ultrasound

Diagnostic Testing and Decision-Making: Beauty Is Not Just in the Eye of the Beholder

“Full Stomach” Despite the Wait: Point‐of‐care Gastric Ultrasound at the Time of Procedural Sedation in the Pediatric Emergency Department

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