Point-of-care biliary ultrasound in the emergency department (BUSED): implications for surgical referral and emergency department wait times

Hilsden, Richard; Leeper, Rob; Koichopolos, Jennifer; Vandelinde, J.; Parry, Neil; Thompson, Drew; Myslik, Frank

doi:10.1136/tsaco-2018-000164

Cited by 43 publications

(59 citation statements)

References 19 publications

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“…One meta-analysis found an LR+ of 7.5 and LR− of 0.12 on EP-performed PoCUS for cholelithiasis [124], similar to a large, retrospective study not included in the meta-analysis [125]. A similar high specificity was found in a more recent study, and a sensitivity of 55% when using eventual need for cholecystectomy as their gold standard [126]. When it comes to cholecystitis, the LR+ ranged from 4.2 to 4.7 and the LR− from 0.05 to 0.39 in three studies of varying design [127–129].…”

Section: Resultssupporting

confidence: 59%

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Sorensen¹,

Hunskaar

2019

Ultrasound J

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Background: Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services.Methods: Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. Results:On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/ thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. Conclusion:Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients. which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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Section: Resultssupporting

confidence: 59%

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Sorensen¹,

Hunskaar

2019

Ultrasound J

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“…The assessment of acute abdominal pain with POCUS must be done in conjunction with a thorough history and clinical examination generating a list of differentials as per the region of the abdomen. POCUS abdomen has been shown to aid and expedite the diagnosis in patients with abdominal trauma with hemoperitoneum, characterize systemic hypoperfusion and shock, detect gallstones, acute cholecystitis, and diagnose ureterolithiasis and assess for pyelonephritis [7][8][9][10]. It can be a useful adjunct for bedside diagnosis of digestive tract diseases such as intussusception, appendicitis, small bowel obstruction, and bowel perforation [3,[11][12][13].…”

Section: Discussionmentioning

confidence: 99%

Point-of-care ultrasound for evaluating intra-abdominal calcification in the pediatric emergency department: case series and review of literature

et al. 2020

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Background The presence of intra-abdominal calcification in the pediatric population can be due to a wide range of conditions. Calcification in the abdomen can be seen in normal or abnormal anatomical structures. In some patients, abnormal calcification points towards the pathology; whereas in others, calcification itself is the pathology. After a thorough history and clinical examination, point-of-care ultrasound (POCUS) would complement the assessment of acute abdominal pain, based on the list of differentials generated as per the abdominal region. The main objective of this article is to review commonly encountered causes of intra-abdominal calcifications in the pediatric population and help in clinical decision-making in a Pediatric Emergency Department. Case presentation We describe a series of pediatric patients who presented to the Pediatric Emergency Department with acute abdominal pain, in whom point-of-care ultrasound helped expedite the diagnosis by identifying varying types of calcification and associated sonological findings. For children who present to the Pediatric Emergency Department with significant abdominal pain, a rapid distinction between emergencies and non-emergencies is vital to decrease morbidity and mortality. Conclusions In a child presenting to the Pediatric Emergency Department with abdominal pain, POCUS and the findings of calcifications can narrow or expand the differential diagnosis when integrated with history and physical exam, to a specific anatomic structure. Integrating these findings with additional sonological findings of an underlying pathology might raise sufficient concerns in the emergency physicians to warrant further investigations for the patient in the form of a formal radiological ultrasound and assist in the patient's early disposition. The use of POCUS might also help to categorize the type of calcification to one of the four main categories of intra-abdominal calcifications, namely concretions, conduit wall calcification, cyst wall calcification, and solid mass-type calcification. POCUS used thoughtfully can give a diagnosis and expand differential diagnosis, reduce cognitive bias, and reduce physician mental load. By integrating the use of POCUS with the history and clinical findings, it will be possible to expedite the management in children who present to the Pediatric Emergency Department with acute abdominal pain.

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“…[25][26][27][28][29][30][31][32][33][34] In rare deadly biliary diseases, such as emphysematous cholecystitis (i.e., acute infection of the gallbladder wall caused by bacterial gas-forming organisms such as Clostridium or Escherichia coli), Bedside US has been concluded to be useful in aiding identification and diagnosis. 35,36 However, Bedside US has not been uniformly adopted in most settings despite these studies. This may be attributed to the lack of ultrasonographic training programs, technology, surgeon perception of Bedside US and the lack of high-quality prospective studies that evaluate point-of-care imaging on operative decision making in patients with cholelithiasis or cholecystitis.…”

Section: Introductionmentioning

confidence: 99%

The Use of Bedside Ultrasound for Gallstone Disease Care within a Community-based Emergency Department: A Confirmation Bias

Gunther

Smith

Boura

et al. 2021

Spartan Medical Research Journal

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INTRODUCTION Traditional evaluation for suspicion of gallstone or gallbladder-related disease includes evaluation with a formal technician-performed ultrasound. However, the use of point-of-care bedside ultrasounds (Bedside US) has been shown to be a viable alternative for the diagnosis of gallstones and gallbladder-related diseases. Purpose Statement : The purpose of this study was to evaluate the impact of Bedside US use in gallbladder evaluation on key patient care outcomes within our community-based emergency department setting. METHODS This retrospective study compared the use of no ultrasound (No US), a formal technician performed ultrasound (Tech US) and Bedside US for gallstone and gallbladder related diseases within a community hospital emergency department between January 1, 2015 and January 1, 2018. Initial vitals, lab work, patient socio-demographics, medical history, emergency department length of stay in hours and disposition were reviewed. RESULTS Of a total N = 449 patients included, patients who received a Bedside US had the fewest computerized tomography scans (No US 62% vs. Tech US 29% vs. Bedside US 16%; p < 0.0001), the shortest median emergency department length of stay (No US 4.5 days vs. Tech US 5.0 days vs. Bedside US 3.0 days; p < 0.0001), and were more likely to be discharged home (No US 41% vs. Tech US 55% vs. Bedside US 81%; p = 0.0006) compared to those that received no ultrasound or a formal ultrasound. Patients who received a Bedside US also had the statistically significant highest incidence of prior cholelithiasis (No US 29.4% vs Tech US 14.3% vs. Bedside US 31.3%; p = 0.001) and lowest total median bilirubin levels (No US 0.5 vs. Tech US 0.5 vs. Bedside US 0.3; p = 0.016) when compared to the other two groups. CONCLUSIONS Although there was a confirmation bias, these study results indicate that point-of-care bedside ultrasound could be a viable alternative for gallstones and gallbladder-related diseases with benefits of use in a community hospital setting.

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Point-of-care biliary ultrasound in the emergency department (BUSED): implications for surgical referral and emergency department wait times

Cited by 43 publications

References 19 publications

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Point-of-care ultrasound for evaluating intra-abdominal calcification in the pediatric emergency department: case series and review of literature

The Use of Bedside Ultrasound for Gallstone Disease Care within a Community-based Emergency Department: A Confirmation Bias

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