Impact of surgeon-performed ultrasound on diagnosis of abdominal pain

Lindelius, Anna; Törngren, S; Sondén, Anders; Pettersson, Hans; Adami, Johanna

doi:10.1136/emj.2007.052142

Cited by 39 publications

(43 citation statements)

References 27 publications

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“…Thus, we found that in biliary emergencies/ other syndromes, 34.51% versus 25% of patients were referred to surgery after US, which is in agreement with the literature data on emergency exploratory surgery for abdominal pain (24.1%) [17].…”

Section: Discussionsupporting

confidence: 91%

Ultrasonography as an integrated tool in clinical decision-making in the Emergency Department

et al. 2016

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The aim of this retrospective study was to identify the role of ultrasonography as a decision-making and screening tool in emergency patients with pathological changes. Material and method: The study was carried out for 28 months in the Emergency Department of the County Emergency University Hospital, Cluj-Napoca. An ultrasound examination was performed as part of the clinical algorithm within the first hour of treating non-critical patients after they had been triaged. The diagnostic decision based on the results of the ultrasound examination was compared with the final diagnosis on discharge from the Emergency Department. Results: In study were included 1565 patients with a mean age of 50.61±19.21 years. Ultrasound changes were detected in a statistically significant number of patients from all the examined subgroups (p≤0.002). The concordance between clinical and ultrasound findings was of 54.06%. Of all the examined patients, 20.63% were referred to surgery department based on the results of the ultrasound examination. Surgery was the final therapeutic decision in 5.06% of all the patients with normal ultrasound findings. Conclusions: Ultrasonography as an integrated tool in the clinical examination algorithm allowed the identification of non-critical patients who required emergency surgery (20.63%). The integration of point-of-care ultrasound into the clinical examination allows the management of emergency patients through the ranking of decisions: hospital admission for surgery and medical treatment, other diagnostic investigations, referral to outpatient care and family physician.

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Section: Discussionsupporting

confidence: 91%

Ultrasonography as an integrated tool in clinical decision-making in the Emergency Department

et al. 2016

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“…The diagnosis based on clinical assessment and ultrasound corresponds with the final diagnosis in 53 - 83% of patients ((EL A2) [2,19,20,21]). In 70% of patients, an urgent diagnosis was correctly identified based on clinical assessment and ultrasound ((EL A2) [2]).…”

Section: Resultsmentioning

confidence: 99%

Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain

Gans

Pols²,

Stoker³

et al. 2015

Dig Surg

169

117

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Introduction: Diagnostic practice for acute abdominal pain at the Emergency Department varies widely and is mostly based on doctor's preferences. We aimed at developing an evidence-based guideline for the diagnostic pathway of patients with abdominal pain of non-traumatic origin. Methods: All available international literature on patients with acute abdominal pain was identified and graded according to their methodological quality by members of the multidisciplinary steering group. A guideline was synthetized, providing evidence-based recommendations together with considerations based on expertise of group members, patient preferences, costs, availability of facilities, and organizational aspects. Conclusions and Recommendations: Definition: Uniform terminology is needed in patients with acute abdominal pain to avoid difficulty in interpretation and ease comparison of findings between studies. We propose the use of the following definition for acute abdominal pain: pain of nontraumatic origin with a maximum duration of 5 days. Clinical diagnosis: Clinical evaluation is advised to differentiate between urgent and nonurgent causes. The diagnostic accuracy of clinical assessment is insufficient to identify the correct diagnosis but can discriminate between urgent and nonurgent causes. Patients suspected of nonurgent diagnoses can safely be reevaluated the next day. Based on current literature, no conclusions can be drawn on the differences in accuracy between residents and specialists. No conclusions can be drawn on the influence of a gynecological consultation. In patients suspected of an urgent condition, additional imaging is justified. CRP and WBC count alone are insufficient to discriminate urgent from nonurgent diagnoses. Diagnostic imaging: There is no place for conventional radiography in the work-up of patients with acute abdominal pain due to the lack of added value on top of clinical assessment. Computed tomography leads to the highest sensitivity and specificity in patients with acute abdominal pain. Positive predictive value of ultrasound is comparable with CT and therefore preferred as the first imaging modality due to the downsides of computed tomography; negative or inconclusive ultrasound is followed by CT. Based on current literature, no conclusions can be drawn on the added value of a diagnostic laparoscopy in the work-up of patients with acute abdominal pain. Antibiotic treatment should be started within the first hour after recognition of sepsis. Administration of opioids (analgesics) decreases the intensity of the pain and does not affect the accuracy of physical examination.

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“…In an earlier report we have shown an increase in diagnostic accuracy from 56.8% to 64.7% by the use of surgeon-performed ultrasound in the ED when patients present with abdominal pain 13. However, the benefits in further management have not been evaluated using a randomised controlled trial design.…”

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confidence: 96%

“…There are studies evaluating the role of surgeon-performed ultrasound in relation to diagnostic accuracy, validity and other potential benefits in abdominal pain management 7 13 – 16. In an earlier report we have shown an increase in diagnostic accuracy from 56.8% to 64.7% by the use of surgeon-performed ultrasound in the ED when patients present with abdominal pain 13.…”

mentioning

confidence: 99%