Utility of common bile duct measurement in ED point of care ultrasound: A prospective study

Lahham, Shadi; Becker, Barbara J.; Gari, Abdulatif; Bunch, S.T.; Alvarado, Maili; Anderson, Craig L.; Viquez, Eric; Spann, Sophia; Fox, J. Christian

doi:10.1016/j.ajem.2017.10.064

Cited by 19 publications

(19 citation statements)

References 25 publications

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“…Bernard et al found that a multimodal educational approach significantly improved the levels of confidence of medical students in scanning the head and neck regions, and that instructor demonstrations were rated as the most crucial component of the program [9]. Recently, point-of-care ultrasound (POCUS) has been increasingly used at patients’ bedside for diagnostic and therapeutic purposes [10, 11] . POCUS also enables emergency or primary care physicians to quickly recognize musculoskeletal and soft tissue disorders and to provide better and safer cares [12].…”

Section: Introductionmentioning

confidence: 99%

Musculoskeletal ultrasound workshops in postgraduate physician training: a pre- and post-workshop survey of 156 participants

Chang

Han

et al. 2019

BMC Med Educ

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Background Use of ultrasonography has revolutionized diagnosis of musculoskeletal disorders. Until now, few studies have investigated usefulness of a short-period workshop for musculoskeletal ultrasound (MSKUS) education. In this research, we attempted to explore (1) whether the physicians felt it useful to attend this type of courses for improving knowledge of sonoanatomy and scanning skills, (2) if the attendees’ perceived confidence in musculoskeletal diagnoses by using ultrasound increased following the program and (3) whether differences existed in perceived usefulness and confidence regrading different sessions of the course. Methods The target participants of the courses were postgraduate physicians without limitation of their specialties. The attendees’ responses to questionnaires before and after the course were reviewed. The workshop contained didactic and practical sessions on 6 major joints in accordance with the scanning protocols of EURO-MUSCULUS/USPRM. The course usefulness and perceived confidence in MSKUS examination were evaluated using a 5-point Likert scale. Data relevant to participants’ pre-workshop confidence levels were also analyzed. If any participant attended the course for more than 1 time, only their first survey was used for analysis. Results The study included 156 participants. The average rating for the course usefulness ranged between 4 (useful) to 5 (very useful). There was no difference in perceived usefulness between the didactic and hands-on practical sessions. Participants’ perceived confidence significantly increased after the workshop but appeared to be lowest for evaluation on the hip joint. Previous experience in performing MSKUS (in years) was consistently associated with the level of pre-workshop confidence. Conclusion A short period ultrasound workshop might be useful regarding making musculoskeletal diagnoses by using ultrasound based on an increase in post-workshop confidence in MSKUS examinations. The perceived confidence of hip scanning was lower than that of other joints after the course, indicating inadequacy of education in hip sonoanatomy and intensity of hand-on practice in the present program. An increase in the faculty-to-student ratio or length of practice in the hip section should be implemented in the future course.

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Section: Introductionmentioning

confidence: 99%

Musculoskeletal ultrasound workshops in postgraduate physician training: a pre- and post-workshop survey of 156 participants

Chang

Han

et al. 2019

BMC Med Educ

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“…One study performed PoCUS on patients presenting with non-traumatic epigastric pain, and found a cholelithiasis prevalence of 39% in this population, even though the treating EP did not initially consider the need for biliary ultrasound in 85% of these cases [132]. A USA study found that the presence of a dilated common bile duct on EP-performed PoCUS, in the absence of laboratory findings or signs of cholecystitis on ultrasound, was unlikely to be a good indicator for complicated biliary pathology (sensitivity 23.7% and specificity 77.9%) [133].…”

Section: Resultsmentioning

confidence: 99%

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Sorensen¹,

Hunskaar

2019

Ultrasound J

104

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Background: Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services.Methods: Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. Results:On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/ thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. Conclusion:Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients. which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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“…35 The Use of Bedside Ultrasound for Gallstone Disease Care within a Community-based Emergency Department: A Confirmation Bias Despite the literature demonstrating the utility of a Bedside US, the use of this modality remains restricted. 44 The arguments against Bedside US use (e g., importance of obtaining an isolated common bile duct dilation measurement, inferiority to an accredited radiography US or limitation with non-fasting patients) have been disproven. 44,45 However, in our study, only 7.2% of our patients received a Bedside US.…”

Section: Discussionmentioning

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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Utility of common bile duct measurement in ED point of care ultrasound: A prospective study

Abstract: Of patients diagnosed with biliary pathology, none had isolated CBD dilatation. In the absence of abnormal laboratory values and GWT, PCF or SMS on POCUS, obtaining a CBD measurement is unlikely to contribute to the evaluation of this patient population.

Cited by 19 publications

References 25 publications

Musculoskeletal ultrasound workshops in postgraduate physician training: a pre- and post-workshop survey of 156 participants

Musculoskeletal ultrasound workshops in postgraduate physician training: a pre- and post-workshop survey of 156 participants

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

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

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