The Accuracy of Point-of-Care Ultrasound in the Diagnosis of Acute Cholecystitis
| Autor: | Elizabeth D. Fox, Soham Parikh, Lillie Tien, Andrew G. Lawson, Asif Talukder, Steven B. Holsten, Chase J. Wehrle, Aditya K. Devarakonda |
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| Rok vydání: | 2021 |
| Předmět: |
Adult
Male medicine.medical_specialty Point-of-Care Systems Guidelines as Topic Hyperemia Timely diagnosis Sensitivity and Specificity 03 medical and health sciences Early surgery 0302 clinical medicine Predictive Value of Tests Acute cholecystitis Cholecystitis Medicine Humans Retrospective Studies Ultrasonography business.industry General surgery Point of care ultrasound Gallbladder General Medicine Middle Aged medicine.disease 030220 oncology & carcinogenesis Acute Disease 030211 gastroenterology & hepatology Female business Emergency Service Hospital |
| Zdroj: | The American surgeon. 88(2) |
| ISSN: | 1555-9823 |
| Popis: | Purpose Acute cholecystitis (AC) affects 50-200 000 patients per year. Early surgery is the treatment of choice for AC. Therefore, timely diagnosis is important to begin proper management. Recently, emergency departments have adopted point-of-care ultrasound (POCUS) for the initial evaluation of AC. The accuracy of POCUS for AC has not been well studied. Methods Patients receiving POCUS for evaluation of AC in the emergency department at our tertiary care institution for 2 years were considered. Patients with previous biliary diagnoses were excluded. Patients were deemed to have AC from a recorded POCUS result or 2/3 of the following POCUS findings: pericholecystic fluid, gallbladder wall hyperemia, and sonographic Murphy’s sign. Formal ultrasound and final diagnosis from surgical and pathology reports were used as gold standards for comparison. Results In total, 147 patients met inclusion criteria. POCUS had a sensitivity and specificity of .4 (95% CI: .1216-.7376) and .99 (.9483-.9982), respectively, when compared to a final diagnosis and .33 (.0749-.7007) and .94 (.8134-.9932) when compared to formal US. The modified Tokyo guidelines for suspicion of AC had a sensitivity of .2 (.0252-.5561) and specificity of .88 (.8173-.931) compared to the final diagnosis. Conclusion Point-of-care ultrasound was not a better screening test than the modified Tokyo guidelines. We recommend a simplified screening approach for AC using clinical findings and laboratory data, followed by confirmatory formal imaging. This strategy could prevent unnecessary delays in surgical management and use of physician resources. |
| Databáze: | OpenAIRE |
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