Ultrasonography by emergency physicians in patients with suspected cholecystitis

A Prospective Evaluation of Emergency Department Bedside Ultrasonography for the Detection of Acute Cholecystitis

“…To facilitate throughput, rapidly narrow the differential diagnosis, and institute early treatment, emergency physicians are increasingly using bedside ultrasonography in the initial evaluation of patients with suspected cholecystitis. [7][8][9][10][11][12][13] Unfortunately, much of the data available on the performance of bedside gallbladder ultrasonography have been determined through comparison to radiology as the criterion standard, rather than clinically significant outcome measures.…”

“…8 In this study, the emergency physician assessed for gallstones and a sonographic Murphy's sign in 116 patients with suspected biliary disease. Patients with a positive screening test result, which was defined as gallstones plus a sonographic Murphy's sign, were sent to radiology for a confirmatory study.…”

“…7 Furthermore, several studies comparing bedside ultrasonography to radiology ultrasonography as the criterion standard have shown that appropriately trained emergency physicians accurately detect gallstones. [8][9][10][11][12][13][14][15] reliability only and do not measure clinically useful outcome parameters, the test characteristics (sensitivity, specificity, predictive values, and likelihood ratios) of bedside ultrasonography for the diagnosis of acute cholecystitis remain uncertain. Without more data to support its use, emergency physicians may be hesitant to utilize bedside ultrasonography for medical decisionmaking and patient disposition.…”

Diagnosis ofacute cholecystitis using ultrasonography

“…Thestatistical analysis of the mean gallbladder wall thickness(2.3 to 8.0mm),The results of our study confirm the literature data showing statistically significant correlations between the parietal dimensions described ultrasonographically and those measured during surgery byBingener et al [28] . Chen and Colab.reported an increasein the conversion risk at a sonographically-measured parietal thickness of more than 6 mm [30,31] . The literature data describe gallstones lodged in the infundibulum as a favoring factor of inflammation [32] .…”

“…US is one of the methods most frequently used in thediagnosis of acute cholecystitis; however, several studies have stressed the limitations of the method related to the operator's expertise, the ultrasound machines used and the possibility of performing the investigation at the bedside [19][20][21] . There are also studies proving the accuracy and advantages of US performed in emergency as compared to hepato- [22,23] or computer tomography [24] .Summers and Colab. studied a better accuracy of US performed in the emergency setting than that of the same method performed by radiologists for the identificationof surgical conditions such as acute cholecystitis [25] .The originality of the study resides in the correlation of the clinical and ultrasonographic aspects with intra-operatory findings, as well as in the analysis of sonographicrole in the diagnosis of different forms of cholecystitis.The incidence of acute cholecystitis was higher in female patients,andmost of the patient who complain of acute calculuscholecystitis created at age between (41-50) years old, The results of the present study confirm the variations in lithiasis incidence, as stated in the epidemiological literature [26,27] .…”