The role of ultrasonography in the diagnosis and management of non-traumatic acute abdominal pain

Abstract

Our aim was to assess the effects of initial ultrasonography (US) evaluation on the diagnosis and management of non-traumatic acute abdominal pain in the emergency department. Three hundred patients with the complaint of non-traumatic acute abdominal pain who were sent for US examination with an initial clinical impression were included in the study. Pre-US and post-US surveys were designed for the clinicians who requested US. The percentage concordance of US findings with the discharge diagnosis made by clinical follow-up, imaging modalities and surgery was determined by calculating the confidence interval. The concordance of the initial clinical impression and the US diagnosis with the discharge diagnosis were compared using the McNemar test. US could not detect any pathology in 102 (34%; 95%CI, 28.6-39.3%) of the patients. The US revealed a different diagnosis than the clinical impression in 69 (23%; 95%CI, 18.2-27.7%), and confirmed the diagnosis in 121 (40%; 95%CI, 34.4-45.5%) patients. The US changed the treatment plans in 47% (95%CI, 41.3-52.6%) of the patients. The clinicians stated US helped them "very much" or "moderately" in making a diagnosis in 83% (95%CI, 78.7-87.2%). When US results were compared with the discharge diagnosis, there was concordance in 238 (79.3%; 95%CI, 74.3-83.6%) patients but not in 62 (20.6%; 95%CI, 16-25.1%). Among 121 patients the initial clinical impression agreed with the US diagnosis and there was concordance with the discharge diagnosis in 105 (86.7%; 95%CI, 80-92.7%). The concordance of US findings with the discharge diagnosis was significantly higher than that of the initial clinical impression statistically. In the initial evaluation of the patients with acute abdominal pain, US is considerably helpful in making the correct diagnosis, and that the concordance with the discharge diagnosis is high. When whole abdominal scanning is not performed, targeted US study according to the initial clinical impression decreases the clinical benefit of US.

The role of emergency ultrasound in the diagnosis of acute non-traumatic epigastric pain

“…In our preliminary study, we have studied 180 adult patients with acute EP consecutively admitted to ED, employing a 2-5 MHz convex probe. Emergency US as a complement to routine management independently achieved a definite diagnosis in 42% of patients, significantly higher than in patients not receiving routine bedside US in our experience and according to the previous reports collecting routine use of US by radiologists [47][48][49] or surgeons [5,50]: biliary diseases (63.6%), acute pancreatitis (10.4%), liver diseases (6.5%), right renal colic with hydronephrosis (2.6%), intestinal occlusion (2.6%), aortic aneurism (2.6%), unknown pregnancy (2.6%), appendicitis (2.6%), mesenteric adenitis from tuberculosis (1.3%), aneurysm of splenic artery (1.3%), advanced surrenalic cancer (1.3%), pancreatic cancer (1.3%), pericarditis (1.3%) (personal communication).…”

“…Moreover, after a positive first-line US examination, the appropriate referral to the surgical or gynecological specialist may be assured, to complete more specific second-level diagnostic procedures [48].…”

US in the evaluation of abdominal pain in a department of internal medicine

“…The proportion of positive examinations was similar to that of previous studies conducted in a general hospital setting (45% in a study by Raman et al) [2] and in emergency departments (42% in a study by Testa et al) [4]. Other studies conducted in emergency department settings reported a higher percentage of positive US findings (66% in a study by Nural et al) [5]. In contrast to these studies, our population included patients from an internal medical department with a high proportion of elderly and very elderly patients (52% and 24%, respectively) presenting with a range of characteristic pathologies, as elderly patients are usually polypathological.…”

“…In contrast with other studies [5], it was not possible to correlate the positive findings with the general clinical picture and further evolution of the patients, such as subsequent imaging studies and final diagnosis, as follow-up was not carried out in this department. For this reason it was not possible to assess if potentially positive findings were the real cause of pain.…”

Guideline for the Diagnostic Pathway in Patients with Acute Abdominal Pain

“…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]).…”