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The double-line sign (DLS) is a wedge-shaped hypoechoic area in Morison's pouch bounded on both sides by echogenic lines. It represents a false-positive finding for free intraperitoneal fluid when performing focused assessment with sonography in trauma examinations. The purpose of this study was to determine the prevalence of DLS. Secondarily, the study will further investigate the relationship between the presence of a DLS and body mass index (BMI). This was a prospective study that enrolled patients over a 7-month period. Inclusion criteria were patients ≥ 18 years of age presenting to the Emergency Department (ED) requiring a FAST examination as part of the patient's standard medical care. Each examination was performed by one of six experienced ultrasonographers. Presence or absence of the DLS was established in real time and gender, height, weight, and BMI were recorded for each patient. The overall prevalence rate of DLS and the corresponding 95 % confidence interval were calculated, as well as the prevalence rates broken down by BMI characterized as underweight, normal weight, overweight, and obese; and age category (18-29, 30-64, and 65+). The Chi-square test and a Fisher's exact test for BMI category were used to compare the prevalence rates of positive DLS among the different demographic groups. 100 patients were enrolled in the study; the overall prevalence was 27 %. There was no statistical significance among the different demographic groups or BMI. The DLS is a prevalent finding. We believe this sign has become more apparent due to improved imaging technology and resolution.

Small bowel obstruction (SBO) is a common diagnosis made in the Emergency Department (ED) representing about 15% of hospital admissions for acute abdominal complaints. We sought to investigate if bedside ultrasound as performed by ED physicians is a reliable test to diagnose and rule out SBO.  This was a prospective cohort study of nonconsecutive patients who presented to an academic, suburban ED with a census of approximately 100,000 patients per year between November 2018 and May 2019. Patients with a history of prior abdominal surgeries who presented to the ED with nausea and/or vomiting and had a CT Abdomen and Pelvis with PO contrast ordered by their provider were consented for a bedside ultrasound. Interpretation was performed by the physician performing the study at bedside. The physician performing the study identified the largest loops of bowel in each of the four quadrants and measured the identified loops from bowel wall to bowel wall.  A diameter of greater than 2.5 cm was considered positive for dilated bowel and probable obstruction. At the completion of the study the physician entered their interpretation of the result which was later reviewed by an ultrasound fellowship-trained physician. There were 101 patients included in the study. Study personnel were accurate in 92% of cases. Overall the sensitivity of point of care ultrasound (POCUS) for SBO was 90% (72.7 to 97.8) and specificity was 92% (82.7 to 96.9). The positive and negative likelihood ratios were 10.76 (4.95 to 23.38) and 0.11 (0.04 to 0.33). Given that our study demonstrated a low negative likelihood ratio, those with low probability of an SBO on history could have an ultrasound examination performed at the bedside which could be sufficient to rule out this disease without requiring patients to undergo further imaging.

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