Diagnostic impact of emergency ultrasound for cholecystitis

Abstract

Background: Previous studies reported different rates of accuracy considering the use of POCUS in diagnosis of cholecystitis indicating that POCUS is not enough when deciding the management. The aim of this study is to compare POCUS findings in the diagnosing of the acute cholecystitis performed by both emergency medicine residents and radiologists. Methods: A retrospective chart review was conducted in the ED of KAMC, Riyadh, Saudi Arabia. The population consisted of patients presented to the ER with RUQ (right upper quadrant pain) and had an abdominal ultrasound performed in the past 6 year. The study used BEST Care system to access the data of patients who underwent ultrasonography, since January 2016 using a data collection sheet. Results: Our results included 1871 patients admitted in KAMC. Emergency physicians had success rate of 25% in correctly reporting the presence or absence of wall thickening, and 44.1% for pericholecystic fluid. In addition, scanning by emergency physicians has a success rate of 60% in detecting CBD dilatation, 12.7% for Murphy’s sign, and 46.3% for acute cholecystitis. Moreover, we found that the presence of thickened gallbladder wall in the ultrasonographic finding is a significant predictor for cholecystitis as it is increasing its incidence by 2.09 times (P=0.038). Conclusions: Ultrasonography conducted by emergency department could be useful in detecting characteristics of gallbladder however, in our study, it showed low accuracy in detecting gallstones and acute cholecystitis compared with surgical and pathological finding.