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

Abstract

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.

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

“…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.…”

“…[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. 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. 6,[13][14][15]59,64 One study found that ED LOS was increased by POCUS utilisation. 60 Four articles described the effect of POCUS on patient disposition in the ED.…”

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

“…8 Patients who have biliary disease diagnosed by POCUS, and are managed without confirmatory imaging, have on average a 2-hour shorter length of stay in the ED. [9][10][11] 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.…”

“…Implementation of POCUS can improve access to care, and more emergency medicine physicians are being trained in biliary POCUS 8. Patients who have biliary disease diagnosed by POCUS, and are managed without confirmatory imaging, have on average a 2-hour shorter length of stay in the ED 9–11. 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.…”