Establishment of ultrasound as a diagnostic aid in the referral of patients with abdominal pain in an emergency department – a pilot study

Abstract

PurposeUltrasonography is a noninvasive, cheap, and fast way of assessing abdominal pain in an emergency department. Many physicians working in emergency departments do not have pre-existing ultrasound experience. The purpose of this study was to investigate the ability of first-year internship doctors to perform a reliable ultrasound examination on patients with abdominal pain in an emergency setting.Materials and methodsThis study took place in an emergency department in Denmark. Following a 1-day ultrasound introduction course, three doctors without prior ultrasound experience scanned 45 patients during a 2-month period. The applicability of the examinations was evaluated by subsequent control examination: computed tomography, operation, or ultrasound by a trained radiologist or gynecologist or, in cases where the patient was immediately discharged, by ultrasound image evaluation.ResultsIn 14 out of 21 patients with a control examination, there was diagnostic agreement between the project ultrasound examination and the control. Image evaluation of all patients showed useful images of the gallbladder, kidneys, liver, abdominal aorta, and urinary bladder, but no useful images for either the pancreas or colon.ConclusionWith only little formal training, it is possible for first-year internship doctors to correctly visualize some abdominal organs with ultrasonography. However, a longer study time frame, including more patients, and an ultrasound course specifically designed for the purpose of use in an emergency department, is needed to enhance the results.

Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

“…3 Ultrasonography (US), on the other hand, is noninvasive, cheap, requires neither the injection of a contrast medium nor radiation, and can be employed quickly as a bedside examination tool. [1][2][3] In most countries, US examinations are performed in radiology departments by specialist radiologists. The resources of the radiology departments are often limited, leading to long waiting times in the ED.…”

“…Patient history, physical examination, and laboratory tests are the primary steps, but they are not always reliable or specific enough to pinpoint an exact diagnosis. 1,2…”

“…Patient history, physical examination, and laboratory tests are the primary steps, but they are not always reliable or specific enough to pinpoint an exact diagnosis. 1,2 Computed tomography (CT) scan, which is considered as diagnostic gold standard in diagnosis of the most abdominal pathologies, is an expensive and time-consuming modality that uses ionizing radiation. 3 Ultrasonography (US), on the other hand, is noninvasive, cheap, requires neither the injection of a contrast medium nor radiation, and can be employed quickly as a bedside examination tool.…”

“…Computed tomography (CT) scan, which is considered as diagnostic gold standard in diagnosis of the most abdominal pathologies, is an expensive and time‐consuming modality that uses ionizing radiation 3 . Ultrasonography (US), on the other hand, is noninvasive, cheap, requires neither the injection of a contrast medium nor radiation, and can be employed quickly as a bedside examination tool 1–3 . In most countries, US examinations are performed in radiology departments by specialist radiologists.…”

“…Studies evaluating diagnostic accuracy and other benefits of EP‐performed US for patients with abdominal pain are fewer, but do exist 2 , 3 . These studies mostly investigate single organ pathologies such as acute appendicitis, acute cholecystitis, and hydronephroses 8–10 .…”