Utility of ultrasound after a negative CT abdomen and pelvis in the emergency department

Harfouch, Nassier; Stern, Jonathan; Chowdhary, Varun; Arias, Yuly; Demissie, Seleshi; Scheiner, Jonathan; Khodorkovsky, Boris; Hayim, Morris

doi:10.1016/j.clinimag.2020.06.007

Cited by 4 publications

(29 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…It found that only 3/132 (2.3%) of abdominal ultrasounds ordered after a negative CT revealed acute pathology potentially requiring surgery. Only one of these three patients (1/132) required surgical intervention for confirmed acute cholecystitis 7 . The follow‐up abdominal ultrasound identified asymptomatic gallstones in 9/132 (6.8%) and gallbladder polyps in 4/132 (3.0%) of cases 7 .…”

Section: Why Ordering An Ultrasound After a Negative Ct Is Unnecessarymentioning

confidence: 99%

“…7 Many providers believe that a CT lacks sensitivity for acute biliary or pelvic pathology and will order an ultrasound to avoid missing an important diagnosis. 7 Within 6 months at a single center, clinicians ordered 614 abdominal ultrasounds within 72 hours of an abdominal CT; 227 of these orders were to evaluate the gallbladder. Clinicians documented a discussion with a radiologist in only 19% of cases.…”

Section: Why You Might Consider Ordering An Abdominal Ultrasound After a Negative Ctmentioning

confidence: 99%

“…6 While CT excludes emergent surgical diagnoses, ultrasound may add value in elucidating a cause of the pain, even when urgent surgical management is not necessary. 7 Many providers believe that a CT lacks sensitivity for acute biliary or pelvic pathology and will order an ultrasound to avoid missing an important diagnosis. 7 Within 6 months at a single center, clinicians ordered 614 abdominal ultrasounds within 72 hours of an abdominal CT; 227 of these orders were to evaluate the gallbladder.…”

Section: Why You Might Consider Ordering An Abdominal Ultrasound Afte...mentioning

confidence: 99%

“…Additionally, ultrasound provides improved anatomic detail of pelvic structures when diagnosing endometrial or ovarian pathology 2 and improves diagnostic accuracy when the initial CT reveals an abnormal pelvic finding (eg, defining an enlarged ovary on CT as ovarian torsion, a cyst, or an adnexal mass) 6 . While CT excludes emergent surgical diagnoses, ultrasound may add value in elucidating a cause of the pain, even when urgent surgical management is not necessary 7 …”

Section: Why You Might Consider Ordering An Abdominal Ultrasound Afte...mentioning

confidence: 99%

“…A 2020 study evaluated the diagnostic yield and clinical impact of ordering an abdominal or pelvic ultrasound within 24 hours of a negative abdominal CT 7 . It found that only 3/132 (2.3%) of abdominal ultrasounds ordered after a negative CT revealed acute pathology potentially requiring surgery.…”

Section: Why Ordering An Ultrasound After a Negative Ct Is Unnecessarymentioning

confidence: 99%

See 4 more Smart Citations

Things We Do for No Reason™: Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain

Cunningham

Wachtel

Shaffie

et al. 2021

Journal of Hospital Medicine

View full text Add to dashboard Cite

Inspired by the ABIM Foundation's Choosing Wisely ® campaign, the "Things We Do for No Reason™" (TWDFNR) series reviews practices that have become common parts of hospital care but may provide little value to our patients. Practices reviewed in the TWDFNR series do not represent clear-cut conclusions or clinical practice standards but are meant as a starting place for research and active discussions among hospitalists and patients. We invite you to be part of that discussion. CLINICAL SCENARIOA 70-year-old woman presented to the emergency department (ED) with diffuse abdominal pain, nausea, and vomiting with normal liver function tests and lipase. Computed tomography (CT) of the abdomen and pelvis with intravenous contrast revealed no acute intraabdominal pathology except for an incidentally noted, mildly enlarged but nondistended gallbladder without evident cholelithiasis, pericholecystic fluid, or gallbladder wall edema. The hospitalist orders an abdominal ultrasound to evaluate for acute biliary pathology potentially missed by CT.

show abstract

Section: Why Ordering An Ultrasound After a Negative Ct Is Unnecessarymentioning

confidence: 99%

Section: Why You Might Consider Ordering An Abdominal Ultrasound After a Negative Ctmentioning

confidence: 99%

Section: Why You Might Consider Ordering An Abdominal Ultrasound Afte...mentioning

confidence: 99%

Section: Why You Might Consider Ordering An Abdominal Ultrasound Afte...mentioning

confidence: 99%

Section: Why Ordering An Ultrasound After a Negative Ct Is Unnecessarymentioning

confidence: 99%

See 3 more Smart Citations

Things We Do for No Reason™: Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain

Cunningham

Wachtel

Shaffie

et al. 2021

Journal of Hospital Medicine

View full text Add to dashboard Cite

show abstract

Acute, Nonspecific, Nontraumatic Abdominal Pain

Silva

Bellolio

2023

Evidence‐Based Emergency Care

View full text Add to dashboard Cite

Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE‐2): Low‐risk, recurrent abdominal pain in the emergency department

Broder

Silva

Bellolio

et al. 2022

Academic Emergency Medicine

View full text Add to dashboard Cite

This second Guideline for Reasonable and Appropriate Care in the Emergency Department (GRACE‐2) from the Society for Academic Emergency Medicine is on the topic “low‐risk, recurrent abdominal pain in the emergency department.” The multidisciplinary guideline panel applied the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach to assess the certainty of evidence and strength of recommendations regarding four priority questions for adult emergency department patients with low‐risk, recurrent, undifferentiated abdominal pain. The intended population includes adults with multiple similar presentations of abdominal signs and symptoms recurring over a period of months or years. The panel reached the following recommendations: (1) if a prior negative computed tomography of the abdomen and pelvis (CTAP) has been performed within 12 months, there is insufficient evidence to accurately identify populations in whom repeat CTAP imaging can be safely avoided or routinely recommended; (2) if CTAP with IV contrast is negative, we suggest against ultrasound unless there is concern for pelvic or biliary pathology; (3) we suggest that screening for depression and/or anxiety may be performed during the ED evaluation; and (4) we suggest an opioid‐minimizing strategy for pain control. EXECUTIVE SUMMARY The GRACE‐2 writing group developed clinically relevant questions to address the care of adult patients with low‐risk, recurrent, previously undifferentiated abdominal pain in the emergency department (ED). Four patient‐intervention‐comparison‐outcome‐time (PICOT) questions were developed by consensus of the writing group, who performed a systematic review of the literature and then synthesized direct and indirect evidence to formulate recommendations, following GRADE methodology. The writing group found that despite the commonality and relevance of these questions in emergency care, the quantity and quality of evidence were very limited, and even fundamental definitions of the population and outcomes of interest are lacking. Future research opportunities include developing precise and clinically relevant definitions of low‐risk, recurrent, undifferentiated abdominal pain and determining the scope of the existing populations in terms of annual national ED visits for this complaint, costs of care, and patient and provider preferences.

show abstract

Utility of ultrasound after a negative CT abdomen and pelvis in the emergency department

Cited by 4 publications

References 21 publications

Things We Do for No Reason™: Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain

Things We Do for No Reason™: Ultrasonography after an initial negative CT in patients presenting with acute abdominal or pelvic pain

Acute, Nonspecific, Nontraumatic Abdominal Pain

Guidelines for Reasonable and Appropriate Care in the Emergency Department 2 (GRACE‐2): Low‐risk, recurrent abdominal pain in the emergency department

Contact Info

Product

Resources

About