The role of ultrasound imaging at detecting aortic aneurysm in emergency department

Abstract

Objective:Our study was carried out to investigate the effects of focused ultrasound imaging which is performed by emergency physicians in diagnosis and duration of treatment of abdominal aortic aneurysm. Methods: The patients over 50 years; who applied to Uludağ University Emergency Department with the complaints of abdominal pain, side pain, chest pain, syncope, unexplained hypotension and under suspicion of the abdominal aortic aneurysm, were included in the study. Bedside ultrasound for abdominal aorta was done and diameter measurements of aorta recorded in order to determine the presence of an abdominal aortic aneurysm or to exclude the diagnosis. Results: A total of 133 patients were included in the study. Eight patients were excluded from the study because of inadequate bedside US imaging. The aortic diameter was measured as ≥ 3 cm in the 54 (43.2%) patients. The aortic diameter was found more than 5 cm in 8 (6.4%) patients. After ultrasonographic investigations, aneurysm rupture (n = 5; 4%), aortic dissction (n = 13; 10.4%) and aortic aneurysm (n =36; 28.8%) were detected. The diagnosis was confirmed with computed tomography in all patients who had aortic pathology. Because of the continuance of clinic suspects in the patients whose aortic diameters were less than 3 cm, their computed tomography images were obtained and their aortic diameters were found within normal limits. Further imaging studies weren't performed at the remaining 48 (38.4%) patients because different prediagnosis was considered. Emergency ultrasound had a sensitivity of 100% (95% CI: 87-100), a specificity of 91% (95% CI: 90.8-99.8). Conclusions:The diagnosis of abdominal aortic aneurysms is omitted 30% in emergency departments. It has a high morbidity and mortality if the diagnosis is skipped. In the presence of aortic aneurysm suspicion, evaluation of aortic diameter by bedside ultrasound is diagnostic. Bedside ultrasound evaluation by emergency physicians should become routine for using time and investigation numbers properly.The European Research Journal 2019;5(4):599-606 cute abdominal pain is a symptom which is presently less than a week, caused by non-traumatic reasons, developed in the progress of patholo-gies of abdominal or non-abdominal organs. Acute abdominal pain is the most important symptom of surgical or medical emergencies [1]. Abdominal pain

Accuracy of presenting symptoms, physical examination, and imaging for diagnosis of ruptured abdominal aortic aneurysm: Systematic review and meta‐analysis

“…We included a total of 20 studies, with a combined 2,077 patients in the meta-analysis. [26][27][28][29][30][31][32][33][34][35][36][37][38][39][40][41][42][43][44][45]…”

“…Following duplicate removal, we screened 4,735 titles and abstracts, 49 of which underwent full‐text review. We included a total of 20 studies, with a combined 2,077 patients in the meta‐analysis 26–45 …”

“…The five studies evaluating accuracy of PoCUS were considered to have potentially high risk of bias for the reference standard, due to their composite reference standard of intraoperative or CTA diagnosis. 30,31,33,35,43…”

“…A total of five studies (628 patients) evaluated the accuracy of PoCUS for the diagnosis of AAA, against the reference standard of CTA or intraoperative diagnosis. 30,31,33,35,43 Only one of these studies discussed the prevalence of indeterminate scans 33 and excluded the 6% of patients with indeterminate imaging from final results. A HSROC model could not be fit, and therefore univariate random-effects meta-analysis was applied.…”