Ultrasonography in Patients Without Trauma in the Emergency Department

Abstract

Objective. The aim of this study was to examine to what extent findings on ultrasonography performed in the emergency department (ED) after hours confirm or alter the referral diagnosis in patients without trauma as reflected in the discharge diagnosis. Methods. In this prospective study, data from 136 ultrasonographic examinations performed in patients without trauma after hours in the ED during January and February 2002 were evaluated against the suspected preimaging diagnosis of the referring ED physician and the actual discharge diagnosis from the ED or after hospitalization. The rate of preimaging and postimaging concordance was statistically analyzed and compared by calculation of confidence intervals and by the McNemar test. Results. Normal ultrasonographic findings were documented in 54 patients (40%), and pathologic findings were documented in 82 (60%). Thirty-four (25%) of the 136 examinations were concordant with the initial referring physician's diagnosis. Of the 102 studies that were not concordant with the initial referral suspected diagnoses, that is, being either a study with normal findings or offering an alternative diagnosis, 81 (79.4%) were concordant with the discharge diagnosis. Conclusions. After-hours ultrasonographic findings in patients without trauma seen in the ED seem to have a high impact on the discharge diagnosis and are concordant with it in more than 80% of cases.

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

“…This ratio is 80.9% in the study of Siegel et al [11] almost the same as ours. Of the 171 patients whose US results were normal or whose US diagnoses were different from the initial clinical diagnosis, 126 (73.7%) were in concordance with the discharge diagnosis.…”

“…It also explains why the number of normal US study findings (34%) and the treatment plan changes are so high. It can be seen in the study of Siegel et al [11] that normal US study findings are high (40%) for the same reason.…”

“…There was concordance with the discharge diagnosis in 105 (86.7%) of the 121 patients whose initial clinical diagnosis were confirmed by an US study. It may be thought that an US study is a time consuming procedure, but for the cases in which a suspected diagnosis has been eliminated, to continue the investigation of other possible pathologies can prevent the possibility of missing any unexplained pathologies that are causing the acute signs and symptoms [11]. We also believe that targeted abdominal US examinations reduce the effectiveness and benefit of an US study, and that a complete abdominal US study is a more effective diagnostic method in patients with acute abdominal pain.…”

Factors predicting significant pathology on ultrasonography in women presenting with non-specific lower abdominal pain

“…However, it should be remembered that ultrasonography should not replace good history taking and examination. 4,10 There are certain limitations of using ultrasonography in the routine management of NSLAP. It could be argued that ultrasonography may help in making an earlier diagnosis but it has economic consequences and carries the risk of false reporting as it is operator dependent.…”

Notfallsonographie im Krankenhaus – Pflicht oder Kür?

“…Der FAST kann jedoch nicht nur die Zeit bis zur Laparotomie reduzieren, sondern auch die Anzahl von CT-Untersuchungen, von Komplikationen, die Hospitalisationsdauer und die Kosten senken [3]. Bei Nicht-Trauma-Patienten wirkt sich die NFS positiv auf Triage-und weitere diagnostisch-therapeutische Entscheidungen aus [4], beeinflusst günstig die korrekte Austrittsdiagnose und die Kosten [5,6], erhöht die Zufriedenheit von Patienten und senkt die Folgeuntersuchungen [7] sowie die Hospitalisationsdauer [8]. Weiter engt sie beim unklaren Schock schnell die Differentialdiagnose ein und hilft bei der korrekten Schlussdiagnose [9].…”