Use of emergency department point-of-care ultrasound in a case of cholecystitis

Lim, Nicolas; McCabe, Aileen; Cronin, John J.

doi:10.1136/bcr-2017-220872

Cited by 3 publications

(3 citation statements)

References 9 publications

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“…Among these cases, the incidence of wall thickening was 79%, 77.7%, and 92% in the finding of emergency physicians, radiologist, and surgery or pathological finding respectively. In addition, 12.5% and 11.0% of cases as compared with surgical and radiological finding which inaccurately reported presence of gallbladder in 2.6% of cases as compared with radiological finding. The results showed significant difference between the finding of emergency physicians as compared with both radiological finding (P=0.000) and surgical finding (P=0.000).…”

Section: Resultsmentioning

confidence: 92%

“…Currently, surgeons are less likely to accept patients for cholecystectomy based on positive emergency physicians' ultrasonography studies alone, instead they are relying on confirmatory ultrasound examinations performed in the radiology department. 9,12 A gap remains between this evidence and the decision to have surgery because of the potential distrust of biliary POCUS. 9 The results of the current study showed that the accuracy of reporting the state of gallbladder disease in emergency physicians' ultrasonography was 87.5% of cases as compared with surgical finding and 86.4% as compared with radiological finding.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic impact of emergency ultrasound for cholecystitis

Alshibani,

Alebrahaimi,

Ahmed

et al. 2023

Int J Res Med Sci

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Background: Previous studies reported different rates of accuracy considering the use of POCUS in diagnosis of cholecystitis indicating that POCUS is not enough when deciding the management. The aim of this study is to compare POCUS findings in the diagnosing of the acute cholecystitis performed by both emergency medicine residents and radiologists. Methods: A retrospective chart review was conducted in the ED of KAMC, Riyadh, Saudi Arabia. The population consisted of patients presented to the ER with RUQ (right upper quadrant pain) and had an abdominal ultrasound performed in the past 6 year. The study used BEST Care system to access the data of patients who underwent ultrasonography, since January 2016 using a data collection sheet. Results: Our results included 1871 patients admitted in KAMC. Emergency physicians had success rate of 25% in correctly reporting the presence or absence of wall thickening, and 44.1% for pericholecystic fluid. In addition, scanning by emergency physicians has a success rate of 60% in detecting CBD dilatation, 12.7% for Murphy’s sign, and 46.3% for acute cholecystitis. Moreover, we found that the presence of thickened gallbladder wall in the ultrasonographic finding is a significant predictor for cholecystitis as it is increasing its incidence by 2.09 times (P=0.038). Conclusions: Ultrasonography conducted by emergency department could be useful in detecting characteristics of gallbladder however, in our study, it showed low accuracy in detecting gallstones and acute cholecystitis compared with surgical and pathological finding.

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Section: Resultsmentioning

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Diagnostic impact of emergency ultrasound for cholecystitis

Alshibani,

Alebrahaimi,

Ahmed

et al. 2023

Int J Res Med Sci

View full text Add to dashboard Cite

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“…[20][21][22][23][24] In gallbladder diseases, Bedside US has been shown to be 55% to 95% sensitive and 82% to 100% specific for cholelithiasis (i.e., the formation of gallstones) and acute cholecystitis, as well as decreased ED length of stay. [25][26][27][28][29][30][31][32][33][34] In rare deadly biliary diseases, such as emphysematous cholecystitis (i.e., acute infection of the gallbladder wall caused by bacterial gas-forming organisms such as Clostridium or Escherichia coli), Bedside US has been concluded to be useful in aiding identification and diagnosis. 35,36 However, Bedside US has not been uniformly adopted in most settings despite these studies.…”

Section: Introductionmentioning

confidence: 99%

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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Point-of-care biliary ultrasound in the emergency department (BUSED): implications for surgical referral and emergency department wait times

Hilsden

Leeper

Koichopolos

et al. 2018

Trauma Surg Acute Care Open

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BackgroundPatients with uncomplicated biliary disease frequently present to the emergency department for assessment. To improve bedside clinical decision making, biliary point-of-care ultrasound (POCUS) in the emergency department has emerged as a diagnostic tool. The purpose of this study is to analyze the usefulness of POCUS in predicting the need for surgical intervention in biliary disease.MethodsA retrospective study of patients visiting the emergency department who received a biliary POCUS from December 1, 2016 to July 15, 2017 was performed. The physician interpretations of the biliary POCUS scans were collected, as well as data from the electronic health records including lab values, the subsequent use of diagnostic imaging, surgical consultation or intervention, and 28 days follow-up for representation or complication.ResultsTwo hundred and eighty-three patients were identified as having received biliary POCUS. Of the patients referred to general surgery who received biliary POCUS 43% received a cholecystectomy. For the outcome of cholecystectomy, the finding of gallstones on POCUS was 55% sensitive (95% CI 40% to 70%) and 92% specific (95% CI 87% to 95%). A sonographic Murphy’s sign was 16% sensitive (95% CI 7% to 30%) but 95% specific (95% CI 92% to 97%) and, gallbladder wall thickness was 18% sensitive (95% CI 9% to 33%) and 98% specific (95% CI 95% to 99%). Patients who received POCUS but did not proceed to confirmatory radiology department imaging had a shorter length of stay (433 min ± 50 min vs. 309 min ± 30 min, P<0.001).DiscussionPoint-of-care biliary ultrasound performed by emergency physicians provides timely access to diagnostic information. Positive findings of gallstones and increased gallbladder wall thickness are highly predictive of the need for surgical intervention, and use of POCUS is associated with shorter ER visits.Level of evidenceRetrospective cohort study, level III.

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Use of emergency department point-of-care ultrasound in a case of cholecystitis

Cited by 3 publications

References 9 publications

Diagnostic impact of emergency ultrasound for cholecystitis

Diagnostic impact of emergency ultrasound for 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): implications for surgical referral and emergency department wait times

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