The impact of analgesia on the diagnostic accuracy of the sonographic Murphyʼs sign

Abstract

This pilot study shows that analgesia does not significantly change the assessment of SMS when performed by an EP sonographer. It also suggests that EP-performed ultrasound may be more accurate in assessing this predictive sign of cholecystitis.

History, Physical Examination, Laboratory Testing, and Emergency Department Ultrasonography for the Diagnosis of Acute Cholecystitis

“…The studies by Summers et al . and Noble et al . failed to document the experience of their ED sonographers.…”

“…Our reviewed studies using RUQ pain or suspected AC (seven studies, ,10,29–34 n = 657 patients) as their primary inclusion criteria and a higher prevalence of AC of 31% (range = 10%–64%) versus 7% (range = 7%–46%) compared to those with abdominal pain (Eskelinen et al., n = 1,333 patients) as their primary inclusion criteria. This clearly suggests a selection bias for AC in those studies using RUQ pain or suspected AC compared to studies including all generalized abdominal pain as their inclusion criteria.…”

“…Four studies, by Kendall and Shimp, Rosen et al., Summers et al., and Noble et al., met our final inclusion criteria for review. Blaivas and Adhikari was removed from final analysis due to concerns of potential biases related to data entry as per the requirements set forth by Gilbert et al .…”

“…Exclusion criteria were only defined by Kendall and Shimp as any patient with ascites or HIV+. Sample sizes varied from 30 to 193 subjects, with mean ages ranging from 36 to 49 years. Female gender predominated in all studies from 79% to 72% …”

TG13 flowchart for the management of acute cholangitis and cholecystitis

“…On the other hand, there is a report demonstrating that mild cases may not require antimicrobial agents; however, prophylactic administration should take place due to possible complications such as bacterial infection. Furthermore, there is a report that was unable to detect a difference in the positive rate of sonographic Murphy's sign depending on the presence or absence of the use of analgesic agents [27]. The administration of analgesic agents should therefore be initiated in the early stage.…”