Point-of-care ultrasonography improves the diagnosis of splenomegaly in hospitalized patients

Abstract

BackgroundIt is important to detect splenomegaly as it can have important diagnostic implications. Previous studies, however, have shown that the traditional physical examination is limited in its ability to rule in or rule out splenomegaly.ObjectiveTo determine if performing point-of-care ultrasonography (POCUS) in addition to the traditional physical examination improves the sensitivity and specificity for diagnosing splenomegaly.MethodsThis was a prospective trial of diagnostic accuracy. Physical and sonographic examinations for splenomegaly were performed by students, residents and attending physicians enrolled in an ultrasound training course. Participants received less than 1 h training for ultrasound diagnosis of splenomegaly. The findings were compared to radiographic interpretation of gold standard studies.Setting/patientsHospitalized adult patients at an academic medical center without severe abdominal pain or recent surgery who had abdominal CT, MRI or ultrasound performed within previous 48 h.ResultsThirty-nine subjects were enrolled. Five patients had splenomegaly (12.5 %). The physical examination for splenomegaly had a sensitivity of 40 % (95 % CI 12–77 %) and specificity of 88 % (95 % CI 74–95 %) while physical examination plus POCUS had a sensitivity of 100 % (95 % CI 57–100 %) and specificity of 74 % (95 % CI 57–85 %). Physical examination alone for splenomegaly had an LR+ of 3.4 (95 % CI 0.83–14) and LR− of 0.68 (95 % CI 0.33–1.41); for physical exam plus POCUS the LR+ was 3.8 (2.16–6.62) and LR− was 0.ConclusionsPoint-of-care ultrasonography significantly improves examiners’ sensitivity in diagnosing splenomegaly.

Point-of-care ultrasound in internal medicine: A position paper by the ultrasound working group of the European federation of internal medicine

“…Seventeen core ultrasound competencies have been identified and they are shown in Table 1 [12][13][14][15][16][17][18][19][20].…”

“…The presence of a collapsable IVC, normal right ventricle and collapsing LV, in the absence of aortic abnormality suggests hypovolemic or distributive (likely septic) shock. On the other hand, the presence of left ventricular dysfunction suggests cardiogenic shock and the presence of right Table 1 Core competencies (p/a = present / absent) [12][13][14][15][16][17][18][19][20]. [31].…”

Comparing Physical Examination With Sonographic Versions of the Same Examination Techniques for Splenomegaly

“…23 In a recent study, with limited training of less than 1 hour in duration on the use of point-of-care sonography, participants using both point-of-care sonography and physical examination techniques were able to improve sensitivity in diagnosing splenomegaly in hospitalized patients. 24 We have previously demonstrated that with limited training, medical residents' measurements of spleen size correlated strongly and significantly with sonographers' measurements. 25 Although longitudinal measurements of spleen size are the reference standard, this approach may pose a challenge to novice sonographers.…”

“…With the increased availability of portable ultrasound technology, there may be a role for bedside sonography in the detection of splenomegaly . In a recent study, with limited training of less than 1 hour in duration on the use of point‐of‐care sonography, participants using both point‐of‐care sonography and physical examination techniques were able to improve sensitivity in diagnosing splenomegaly in hospitalized patients . We have previously demonstrated that with limited training, medical residents' measurements of spleen size correlated strongly and significantly with sonographers' measurements …”

Comparison of Spleen, Liver and Kidney Volume and Span using Multiplanar CT Scan vs. Ultrasonography in 1-12 year-old Patients

“…Splenomegaly is also an important finding for physicians, and like hepatomegaly, physical examination is of low sensitivity and specificity in diagnosing it (3). And alike, biomedical imaging is of importance.…”