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

Abstract

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.

Accuracy of Ultrasound and Computed Tomography in Diagnosing Acute Cholecystitis Patients in a Tertiary Care Center in Saudi Arabia

“…In our institution, it was found that the most common US finding is gallstones. Similarly, a previous study in Romania showed that US is highly accurate in diagnosing cholelithiasis [30]. Several studies also noted that US is an efficient imaging modality in diagnosing gallbladder stones [16,17,31].…”

Point‐of‐care ultrasound to diagnose acute cholecystitis in the emergency department: A scoping review

“…70 Two smaller studies found similar accuracy of ultrasound in the same application. 71,72 Despite this, ultrasound remains the first-line modality for acute cholecystitis due to its widespread availability, minimal invasiveness, absence of radiation and cost-effectiveness. 7,8,[73][74][75] Clearly, comparing POCUS to a more accurate reference standard is likely to generate lower POCUS accuracy.…”

“…Magnetic resonance imaging, computed tomography and cholescintigraphy were all found to be more accurate than ultrasound in diagnosing acute cholecystitis in an earlier meta‐analysis, with ultrasound reported to have a sensitivity of 81% and a specificity of 83% 70 . Two smaller studies found similar accuracy of ultrasound in the same application 71,72 . Despite this, ultrasound remains the first‐line modality for acute cholecystitis due to its widespread availability, minimal invasiveness, absence of radiation and cost‐effectiveness 7,8,73–75 .…”

External validation of the bedside score for the diagnosis of acute cholecystitis

“…Therefore, ultrasonography is the most common initial imaging test in the evaluation of acute cholecystitis. However, the accuracy of ultrasonography alone is controversial [ [10] , [11] , [12] , [13] , [14] , [15] ], and its sensitivity ranges from 50 % to 95 % [ 16 , 17 ].…”