Prospective validation of the bedside sonographic acute cholecystitis score in emergency department patients

Graglia, Sally; Shokoohi, Hamid; Loesche, Michael A.; Yeh, D. Dante; Haney, Rachel M.; Huang, Calvin; Morone, Christina; Springer, Caitlin; Kimberly, Heidi H.; Liteplo, Andrew S.

doi:10.1016/j.ajem.2020.12.085

Cited by 10 publications

(11 citation statements)

References 13 publications

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“…Indeed, cholecystitis is known to be secondary to gallstones in 95% to 99% of cases in an emergency setting [ 26 ]. It has also been demonstrated that PoCUS can be useful to rule out cholecystitis [ 27 ]. Ruling-in and ruling-out are two distinct processes that strengthen physical evaluations and improve diagnostic approaches.…”

Section: Discussionmentioning

confidence: 99%

Is gallbladder PoCUS diagnostic accuracy accessible to medical students after PoCUS training exclusively on healthy volunteers? A pilot randomized control trial

et al. 2023

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Background Point-of-care ultrasound (PoCUS) is increasingly used in clinical practice and is now included in many undergraduate curricula. Here, we aimed to determine whether medical students who participated in a PoCUS teaching program with several practical training sessions involving healthy volunteers could achieve a good level of diagnostic accuracy in identifying gallbladder pathologies. The intervention group (IG) was trained exclusively on volunteers with a healthy gallbladder, whereas the control group (CG) had access to volunteers with a pathological gallbladder as recommended in most PoCUS curricula. Materials and methods Twenty medical students were randomly assigned to the IG and CG. After completing the training program over 2 months, students were evaluated by three independent examiners. Students and examiners were blind to group allocation and study outcome. Sensitivity and specificity of students’ PoCUS gallstone diagnosis were assessed. Secondary outcomes were students’ confidence, image quality, acquisition time, and PoCUS skills. Results Sensitivity and specificity for gallstone diagnosis were, respectively, 0.85 and 0.97 in the IG and 0.80 and 0.83 in the CG. Areas under the curve (AUC) based on the receiver operating characteristic curve analysis were 0.91 and 0.82 in the IG and CG, respectively, with no significant difference (p = 0.271) and an AUC difference of -0.092. No significant between-group difference was found for the secondary outcomes. Conclusions Our pilot study showed that medical students can develop PoCUS diagnostic accuracy after training on healthy volunteers. If these findings are confirmed in a larger sample, this could favor the delivery of large practical teaching sessions without the need to include patients with pathology, thus facilitating PoCUS training for students.

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Section: Discussionmentioning

confidence: 99%

Is gallbladder PoCUS diagnostic accuracy accessible to medical students after PoCUS training exclusively on healthy volunteers? A pilot randomized control trial

et al. 2023

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“…USG imaging has been the first preferred diagnostic imaging method in many guidelines [16]. In fact, its diagnostic efficiency has been demonstrated with a high sonographic AC score in a prospective bedside USG validation study [17]. However, USG imaging is operator-dependent, and it can be difficult to diagnose AC in the emergency department because it requires patient compliance.…”

Section: Discussionmentioning

confidence: 99%

Can immature granulocytes be used as a predictive new marker in the diagnosis of acute cholecystitis?

Korkut¹,

Bedel²,

Selvi³

et al. 2022

J CLIN MED KAZ

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Aim: Acute cholecystitis (AC) is one of the most common acute surgical diseases in the emergency department (ED). The aim of this study was to investigate the efficacy of inflammatory parameters as immature granulocyte count (IGC) and immature granulocyte percentage (IG%) in the diagnosis of AC.Material and methods: This retrospective and observational study consisted of patients, diagnosed with AC, who were admitted to a tertiary ED with abdominal pain between March 2019 and April 2021. The effectiveness of IGC and IG% in the diagnosis of AC was examined by comparing the results with the control group (CG).Results: A total of 493 patients were included in the study. 270 patients were in the AC group, 223 patients were in the CG. IG% and IGC were found to be significantly higher in the AC group than in the CG (0.5 (0.32) vs. 0.4 (0.2); 0.06 (0.08) vs. 0.03 (0.03); p<0.001, p<0.001 respectively). It has been shown that IGC, at a cut-off value of 0.03, predicts the diagnosis of AC with 72.1% sensitivity and 55.5% specificity. On the other hand, IG%, at a cut-off value of 0.45, predicts the diagnosis of AC with 53.2% sensitivity and 72.7% specificity (AUC [0.717 (0.672-0.762); 0.692 (0.645-0.738)], respectively p<0.001, p<0.001).Conclusions: In conclusion, IGC and IG% can be used as a useful inflammatory parameter in the diagnosis of AC in patients admitted to the emergency department.

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“…55 Resource utilisation in the ED Fourteen articles described the effect of POCUS on resource utilisation in the ED when used on patients with symptoms suspicious of biliary disease (Table 5). [13][14][15][16][57][58][59][60][61][62][63][64][65][66] In all 14 articles, POCUS operators were ED doctors, with variable levels of POCUS expertise, where specified. Seven were retrospective observational studies, [13][14][15]61,62,64 and five were prospective observational studies.…”

Section: Pocus Operator Trainingmentioning

confidence: 99%

“…Seven were retrospective observational studies, [13][14][15]61,62,64 and five were prospective observational studies. 16,57,58,60,63 There was one case series 59 and one case report. 65 Six studies found that POCUS utilisation in the ED reduced ED length of stay (LOS) in this context.…”

Section: Pocus Operator Trainingmentioning

confidence: 99%

Point‐of‐care ultrasound to diagnose acute cholecystitis in the emergency department: A scoping review

Joyce,

Snelling,

Elsayed

et al. 2023

Australas J Ultrason Med

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Introduction/PurposeUltrasound is the first‐line imaging modality for suspected acute cholecystitis. This can be radiology‐performed ultrasound or point‐of‐care ultrasound (POCUS). POCUS can potentially streamline patient assessment in the emergency department (ED). The primary objective was to evaluate the literature for the diagnostic accuracy of POCUS performed for acute cholecystitis in the ED. Secondary objectives were to assess the effect of POCUS operator training on diagnostic accuracy for acute cholecystitis, utility of POCUS measurement of the common bile duct and POCUS impact on resource utilisation.MethodsA systematic scoping review of articles was conducted using Medline, Embase, CENTRAL and CINAHL. Original studies of adults with POCUS performed for the diagnosis of acute cholecystitis in the ED were included. The study was reported using the Preferred Reporting Items for Systematic Reviews and Meta‐Analyses extension for Scoping Reviews checklist (PRISMA‐ScR).ResultsA total of 1090 publications were identified. Forty‐six met the eligibility criteria. Studies were thematically grouped into categories according to specified objectives. Point‐of‐care ultrasound was of acceptable but variable accuracy, contributed to by the absence of a consistent reference standard and uniform training requirements. It may positively impact ED resource utilisation through reduced ED length of stay and radiology‐performed imaging, whilst improving patient experience.ConclusionThis review highlights the heterogeneity of existing research, emphasising the need for standardisation of training and reference standards in order to precisely define the utility of POCUS for acute cholecystitis in the ED and its benefits on ED resource utilisation.

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Prospective validation of the bedside sonographic acute cholecystitis score in emergency department patients

Cited by 10 publications

References 13 publications

Is gallbladder PoCUS diagnostic accuracy accessible to medical students after PoCUS training exclusively on healthy volunteers? A pilot randomized control trial

Is gallbladder PoCUS diagnostic accuracy accessible to medical students after PoCUS training exclusively on healthy volunteers? A pilot randomized control trial

Can immature granulocytes be used as a predictive new marker in the diagnosis of acute cholecystitis?

Point‐of‐care ultrasound to diagnose acute cholecystitis in the emergency department: A scoping review

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