Performance and interpretation of focused right upper quadrant ultrasound by emergency physicians

Kendall, John L.; Shimp, Richard J

doi:10.1016/s0736-4679(01)00329-8

Cited by 100 publications

(96 citation statements)

References 9 publications

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“…Prior studies of POCUS have assessed whether emergency physicians can accurately detect gallstones as well as acute cholecystitis, mainly compared to a reference standard of radiology ultrasound (6,7,9,10). In these studies the definition of the POCUS test for acute cholecystitis includes gallstones plus a secondary finding.…”

Section: Discussionmentioning

confidence: 99%

“…Summers et al reported a negative predictive value of 97% (95% CI 93-99%) and negative likelihood ratio of 0.16 (95% CI 0.06-0.5), which would suggest this as a reasonable approach (5). Prior studies of POCUS of the gallbladder have demonstrated a more modest sensitivity for AC (6)(7)(8)(9). In a recent systematic review of point-of-care ultrasound for gallstones, the authors suggest that ''a negative emergency ultrasonography result for gallstones .…”

Section: Introductionmentioning

confidence: 99%

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The Absence of Gallstones on Point-of-Care Ultrasound Rules Out Acute Cholecystitis

Villar

Summers

Menchine

et al. 2015

The Journal of Emergency Medicine

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, Abstract-Background: Cholelithiasis affects an estimated 20 million people in the United States yearly; 20% of symptomatic patients will develop acute cholecystitis (AC). A recent single-center study estimating test characteristics of point-of-care ultrasonography (POCUS) for the detection of AC, as defined by gallstones plus sonographic Murphy's or pericholecystic fluid or gallbladder wall-thickening, resulted in a sensitivity and specificity of 87% (95% confidence interval [CI] 66-97) and 82% (95% CI 74-88), respectively. No prior studies have been conducted to estimate the test characteristics of POCUS for the purpose of excluding acute calculous cholecystitis. Objective: To determine whether the finding of gallstones alone on POCUS has high sensitivity, high negative predictive value, and low negative likelihood ratio for the exclusion of AC. Methods: We conducted an analysis using data from a prospective cross-sectional single-center study of POCUS test to estimate the test characteristics using a simplified definition of a positive test -the presence of gallstones alone. Clinical follow-up and pathology reports were used as the reference standard. Test characteristics were calculated and compared to the standard definition, gallstones plus one secondary finding. Results: The overall prevalence of AC was 14% (23 pathology-confirmed cases of 164 included patients). The sensitivity of the simplified definition was 100% (95% CI 85.7-100), negative predictive value 100% (95% CI 92.2-100), and negative likelihood ratio was < 0.1, compared to a sensitivity of 87% (95% CI 66-97%), negative predictive value 97% (95% CI 93-99%), and negative likelihood ratio of 0.16 (95% CI 0.06-0.5).Conclusion: Simplifying the definition of the test findings on POCUS to gallstones alone has excellent sensitivity and negative predictive value for the exclusion of AC. This finding, if broadly validated prospectively, confirms the practice of excluding acute calculous cholecystitis using POCUS in emergency department patients. Ó 2015 Elsevier Inc.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

The Absence of Gallstones on Point-of-Care Ultrasound Rules Out Acute Cholecystitis

Villar

Summers

Menchine

et al. 2015

The Journal of Emergency Medicine

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“…To facilitate throughput, rapidly narrow the differential diagnosis, and institute early treatment, emergency physicians are increasingly using bedside ultrasonography in the initial evaluation of patients with suspected cholecystitis. [7][8][9][10][11][12][13] Unfortunately, much of the data available on the performance of bedside gallbladder ultrasonography have been determined through comparison to radiology as the criterion standard, rather than clinically significant outcome measures.…”

Section: Discussionmentioning

confidence: 99%

“…7 Furthermore, several studies comparing bedside ultrasonography to radiology ultrasonography as the criterion standard have shown that appropriately trained emergency physicians accurately detect gallstones. [8][9][10][11][12][13][14][15] reliability only and do not measure clinically useful outcome parameters, the test characteristics (sensitivity, specificity, predictive values, and likelihood ratios) of bedside ultrasonography for the diagnosis of acute cholecystitis remain uncertain. Without more data to support its use, emergency physicians may be hesitant to utilize bedside ultrasonography for medical decisionmaking and patient disposition.…”

Section: Introduction Backgroundmentioning

confidence: 99%

A Prospective Evaluation of Emergency Department Bedside Ultrasonography for the Detection of Acute Cholecystitis

Summers

Scruggs

Menchine

et al. 2010

Annals of Emergency Medicine

128

103

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Study objective: We assess the diagnostic accuracy of emergency physician-performed bedside ultrasonography and radiology ultrasonography for the detection of cholecystitis, as determined by surgical pathology. Methods:We conducted a prospective, observational study on a convenience sample of emergency department (ED) patients presenting with suspected cholecystitis from May 2006 to February 2008. Bedside gallbladder ultrasonography was performed by emergency medicine residents and attending physicians at an academic institution. Emergency physicians assessed for gallstones, a sonographic Murphy's sign, gallbladder wall thickness, and pericholecystic fluid, and the findings were recorded before formal imaging. The test characteristics of bedside and radiology ultrasonography were determined by comparing their respective results to pathology reports and clinical follow-up at 2 weeks.Results: Of the 193 patients enrolled, 189 were evaluated by bedside ultrasonography. Forty-three emergency physicians conducted the ultrasonography, and each physician performed a median of 2 tests. After the bedside ultrasonography, 125 patients received additional radiology ultrasonography. Twenty-six patients underwent cholecystectomy, 23 had pathology-confirmed cholecystitis, and 163 were discharged home to follow-up. Twenty-five were excluded (23 lost to follow-up and 2 unavailable pathology). The test characteristics of bedside ultrasonography were sensitivity 87% (95% confidence interval [CI] 66% to 97%), specificity 82% (95% CI 74% to 88%), positive likelihood ratio 4.7 (95% CI 3.2 to 6.9), negative likelihood ratio 0.16 (95% CI 0.06 to 0.46), positive predictive value 44% (95% CI 29% to 59%), and negative predictive value 97% (95% CI 93% to 99%). The test characteristics of radiology ultrasonography were sensitivity 83% (95% CI 61% to 95%), specificity 86% (95% CI 77% to 92%), positive likelihood ratio 5.7 (95% CI 3.3 to 9.8), negative likelihood ratio 0.20 (95% CI 0.08 to 0.50), positive predictive value 59% (95% CI 41% to 76%), and negative predictive value 95% (95% CI 88% to 99%). Conclusion:The test characteristics of emergency physician-performed bedside ultrasonography for the detection of acute cholecystitis are similar to the test characteristics of radiology ultrasonography. Patients with a negative ED bedside ultrasonography result are unlikely to require cholecystectomy or admission for cholecystitis within 2 weeks of their initial presentation.

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“…There was also no mention of studies such as those published by Plummer et al 7 and Rozycki et al 8,9 that showed the utility and improved outcome of patients with penetrating chest injuries who were evaluated by sonography. Contributions from other emergency physicians in areas such as aorta, 10-13 gallbladder, [14][15][16] renal, 17 pelvic, [18][19][20][21][22] and vascular [23][24][25][26][27][28][29] sonography were also left out. Finally, indications for ultrasound that are specific to emergency medicine such as the sonographic evaluation of the patient presentation of cardiac arrest, hypotension, and undifferentiated shock were not discussed.…”

Section: History Of Emergency Ultrasoundmentioning

confidence: 99%

History of Emergency Ultrasound

Kendall

Blaivas

Hoffenberg

et al. 2004

J of Ultrasound Medicine

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Performance and interpretation of focused right upper quadrant ultrasound by emergency physicians

Cited by 100 publications

References 9 publications

The Absence of Gallstones on Point-of-Care Ultrasound Rules Out Acute Cholecystitis

The Absence of Gallstones on Point-of-Care Ultrasound Rules Out Acute Cholecystitis

A Prospective Evaluation of Emergency Department Bedside Ultrasonography for the Detection of Acute Cholecystitis

History of Emergency Ultrasound

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