Surgeon attitudes toward point of care ultrasound for biliary disease: a nationwide Canadian survey

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

doi:10.1503/cjs.010218

Cited by 7 publications

(9 citation statements)

References 3 publications

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“…About half (48.9%, 65/120) felt that the sensitivity of POCUS was less than 50%. 9 Understanding the accuracy of POCUS will help determine whether it is a modality that can enhance diagnostic accuracy obtained from clinical and radiologist-based assessments. Our study was designed to evaluate the accuracy of ED POCUS, using gold standard diagnostic techniques such as a formal ultrasound, abdominal CT scan, and final diagnosis obtained from surgical and pathology findings.…”

Section: Introductionmentioning

confidence: 99%

The Accuracy of Point-of-Care Ultrasound in the Diagnosis of Acute Cholecystitis

Wehrle

Talukder

Tien

et al. 2021

The American Surgeon

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Purpose Acute cholecystitis (AC) affects 50-200 000 patients per year. Early surgery is the treatment of choice for AC. Therefore, timely diagnosis is important to begin proper management. Recently, emergency departments have adopted point-of-care ultrasound (POCUS) for the initial evaluation of AC. The accuracy of POCUS for AC has not been well studied. Methods Patients receiving POCUS for evaluation of AC in the emergency department at our tertiary care institution for 2 years were considered. Patients with previous biliary diagnoses were excluded. Patients were deemed to have AC from a recorded POCUS result or 2/3 of the following POCUS findings: pericholecystic fluid, gallbladder wall hyperemia, and sonographic Murphy’s sign. Formal ultrasound and final diagnosis from surgical and pathology reports were used as gold standards for comparison. Results In total, 147 patients met inclusion criteria. POCUS had a sensitivity and specificity of .4 (95% CI: .1216-.7376) and .99 (.9483-.9982), respectively, when compared to a final diagnosis and .33 (.0749-.7007) and .94 (.8134-.9932) when compared to formal US. The modified Tokyo guidelines for suspicion of AC had a sensitivity of .2 (.0252-.5561) and specificity of .88 (.8173-.931) compared to the final diagnosis. Conclusion Point-of-care ultrasound was not a better screening test than the modified Tokyo guidelines. We recommend a simplified screening approach for AC using clinical findings and laboratory data, followed by confirmatory formal imaging. This strategy could prevent unnecessary delays in surgical management and use of physician resources.

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Section: Introductionmentioning

confidence: 99%

The Accuracy of Point-of-Care Ultrasound in the Diagnosis of Acute Cholecystitis

Wehrle

Talukder

Tien

et al. 2021

The American Surgeon

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“…28,31 A recent 2020 survey evaluating Canadian general surgeons' perceptions of a biliary Bedside US revealed that most surgeons believed the sensitivity of Bedside US to be much lower for cholelithiasis and cholecystitis than actual literature results. 49 Results from a similar study mirrored the lack of confidence by general surgery and other consultants on trusting Bedside US performed by emergency medicine physicians. 50 Meanwhile, there remains a paucity of studies in which the Bedside US was the sole modality of imaging for diagnosing biliary disease resulting in operative management.…”

Section: Discussionmentioning

confidence: 75%

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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“…Lack of confidence in the accuracy of POCUS and its ability to provide the requisite information seems to be chief among these concerns, despite the literature demonstrating that POCUS is reliable. 13 In jurisdictions such as the USA, concerns over medicolegal risk and/or financial incentives may be a barrier to adoption of POCUS for surgical decision-making. The research presented in this article suggests that the subspecialty of the surgeon managing the patient may have an influence.…”

Section: Discussionmentioning

confidence: 99%

“… 12 A recent Canadian national survey showed that 60% of practicing surgeons had a total lack of confidence in ED POCUS for the diagnosis of biliary disease. 13 This lack of confidence leads many surgeons to seek confirmatory radiology department imaging prior to operating on the gallbladder. The unanswered question is whether this additional step of obtaining a RUS adds value for the surgeon over the information available by POCUS.…”

Section: Introductionmentioning

confidence: 99%

“…Despite the literature demonstrating reliability and potential benefits of biliary POCUS, there has been a lack of adoption for the purpose of surgical decision-making 12. A recent Canadian national survey showed that 60% of practicing surgeons had a total lack of confidence in ED POCUS for the diagnosis of biliary disease 13. This lack of confidence leads many surgeons to seek confirmatory radiology department imaging prior to operating on the gallbladder.…”

Section: Introductionmentioning

confidence: 99%

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Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions

Hilsden

Mitrou

Hawel

et al. 2022

Trauma Surg Acute Care Open

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ObjectivesGallstone disease is a common reason for emergency department (ED) presentation. Surgeons often prefer radiology department ultrasound (RUS) over point of care ultrasound (POCUS) because of perceived of unreliability. Our study was designed to test the hypothesis that POCUS is sufficient to guide the management of surgeons treating select cases of biliary disease as compared to RUS.MethodsThis was a prospective cohort study. Patients who presented to the ED with abdominal pain and findings of biliary disease on POCUS were included. The surgeon was then presented the case with POCUS only and recorded their management decision. Patients then proceeded to RUS, were followed through their stay, and analysis was performed to analyze the proportion of patients where the introduction of the RUS changed the management plan.Results100 patients were included in this study, and all received both POCUS and RUS. Depending on the surgeons’ POCUS based management decisions, the patients were divided into three groups: (1) surgery, (2) duct clearance, (3) no surgery. Total bilirubin was 34±22 mmol/L in the duct clearance group vs 8.4±6.5 mmol/L and 16±12 mmol/L in the surgery and no surgery groups, respectively (p<0.05). POCUS results showed 68 patients would have been offered surgery, 21 offered duct clearance, and 11 no surgery. In 90% of cases, the introduction of RUS did not change management. The acute care surgeons elected to operate on patients more frequently than other surgical subspecialties (p<0.05).ConclusionsThis study showed that fewer than 10% of patients with biliary disease seen on POCUS had a change in surgical decision-making based on the addition of RUS imaging. In uncomplicated cases of biliary disease, relying on POCUS imaging for surgical decision-making has the potential to improve patient flow.Level of evidenceII Prospective Cohort Study.

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Surgeon attitudes toward point of care ultrasound for biliary disease: a nationwide Canadian survey

Cited by 7 publications

References 3 publications

The Accuracy of Point-of-Care Ultrasound in the Diagnosis of Acute Cholecystitis

The Accuracy of Point-of-Care Ultrasound in the Diagnosis of Acute Cholecystitis

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

Point of care biliary ultrasound in the emergency department (BUSED) predicts final surgical management decisions

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