Diagnostic Accuracy of Point-of-Care Ultrasound Integrated into Clinical Examination for Acute Diverticulitis: A Prospective Multicenter Study

Abstract

Purpose Diverticulitis is a common cause of abdominal pain and CT scan is commonly used for its diagnosis in the emergency department (ED). The diagnostic performance of point-of-care ultrasound (POCUS) integrated into a clinical exam for diverticulitis is still not established. We evaluate the accuracy of clinical-sonographic assessment for the diagnosis of diverticulitis and whether POCUS could improve the selection of patients needing CT scan for complicated diverticulitis. Materials and Methods This is a multicentric observational study involving adult patients suspected of having diverticulitis presenting at 4 EDs. 21 sonographer physicians were asked to diagnose diverticulitis and complicated diverticulitis based on clinical-sonographic assessment. The final diagnosis was established by two reviewers, blinded to POCUS, based on data collected during the one-month follow-up comprehensive CT scan. Results Among 393 enrolled patients, 218 (55.5 %) were diagnosed with diverticulitis and 33 (8 %) had complicated diverticulitis. The time to diagnosis by the sonographer physicians was shorter compared to standard care (97 ± 102 vs. 330 ± 319 minutes, p < 0.001). Clinical-sonographic assessment showed optimal sensitivity (92.7 %) and specificity (90.9 %) for diverticulitis. However, the sensitivity (50 %) for complicated diverticulitis was low. The sonographer physician would have proceeded to CT scan in 194 (49.4 %) patients and the CT scan request compared to the final diagnosis of complicated diverticulitis demonstrated 94 % sensitivity. Conclusion Clinical-sonographic assessment is rapid and accurate for the diagnosis of diverticulitis. Even if POCUS has low sensitivity for complicated diverticulitis, it can be used to safely select patients needing CT.

Emergency Department Point-of-Care Ultrasound Diagnosis of a Large Bowel Obstruction Due to Metastatic Rectal Cancer: A Case Report

“…In SBO, POCUS may have sensitivity and specificity values as high as 92.4% and 96.6%, respectively, with sonographic findings of dilated, fluid-filled bowel loops >2.5 cm and increased peristalsis [ 12 ]. For diverticulitis, POCUS may have sensitivity and specificity values of up to 92% and 97%, respectively, for uncomplicated diverticulitis with sonographic findings of bowel wall thickening >5 mm around a diverticulum, pericolonic fat enhancement, and sonographic tenderness to palpation [ 13 - 14 ]. Although the use of POCUS for LBO has not been as extensively studied when compared to SBOs, an interdisciplinary group of experts has suggested that ultrasound may be able to diagnose LBO with diagnostic criteria involving visualization of a large intestine >4.5 cm in diameter, abdominal A-lines, abnormal bowel peristalsis, and thickened plicae circulares >2 mm [ 15 - 16 ].…”

Ultrasound, the handyman serving our whole populations in the post COVID-19 pandemic

“…For instance, if we consider the ages of the population, these articles show how ultrasound is regularly utilized with great benefit at any time of the human life. Its use spans from the very early times, like the prenatal intrauterine conditions [1], moving to the perinatal period [2], the adult life [3,4], times at which CT or MRI are scantly of any use and finally to the disease of the elderly, such as Alzheimer's dementia [5]. Not only applications of ultrasonography cover the entire spectrum of human life in terms of time, but the size and price of the scanners range from relatively large top level scanners movable only on wheels, where the newest advanced technologies can be implemented [3] and valued over 100 000 Euros, to pocket size scanners, which are conveniently utilized at the bedside [6] and easily held in one hand.…”

“…This has been defined as the Sonography-Assisted Medical Examination (SAME) [16,17]. An example of this concept is illustrated also in an article of the present issue [4]. Therefore also from this point of view ultrasound is showing the widest range of applications in terms of organs regularly investigated to the setting of use, spanning from top radiology enviroments with Multiparametric ultrasound, to clinical wards, to the emergency department and intensive care units to territorial services, ambulances and increasingly also the home of patients.…”

“…Betrachtet man beispielsweise das Alter der Bevölkerung, so zeigen diese Arbeiten, wie Ultraschall regelmäßig und mit großem Nutzen in jeder Lebensphase angewandt wird. Sein Einsatz erstreckt sich von den sehr frühen Phasen, wie den pränatalen intra-uterinen Erkrankungen [1], bis zur Perinatalperiode [2], dem Erwachsenenalter [3,4], Zeiten, in denen CT oder MRT kaum von Nutzen sind, bis hin zu den Erkrankungen im Alter, wie der Alzheimer-Demenz [5]. Die sonografischen Anwendungen decken nicht nur die gesamte Zeitspanne eines menschlichen Lebens ab.…”

“…Dies wurde als Sonografie-gestützte medizinische Untersuchung ("Sonography-assisted medical Examination" SAME) definiert [16,17]. Dieses Konzept wird auch in einem Artikel in dieser Ausgabe vorgestellt [4] Daher zeigt der Ultraschall auch unter diesem Gesichtspunkt das breiteste Anwendungsspektrum. Dies betrifft sowohl die regelmäßig untersuchten Organe als auch das Einsatzgebiet, das von der Spitzenradiologie mit multiparametrischem Ultraschall, über die Klinikstationen, die Notaufnahme und die Intensivstationen bis zu den lokalen Rettungsdiensten, Ambulanzen und zunehmend auch bis ins das Zuhause der Patienten reicht.…”