Bedside Ultrasonography in the ED Detects Acute Cholecystitis
Last Updated: 2010-03-05 17:04:20 -0400 (Reuters Health)
"Regardless of a surgeon's need for radiology studies, if I can rule out gallbladder disease at the time of presentation I don't have to wait 2 hours for radiology to do that for me," Dr. William Scruggs, an emergency physician and an author of the report, told Reuters Health by email. "I can move on to whatever study really needs to be done (if any). That decreases costs and time for patients in the emergency department."
Dr. Scruggs and his colleagues at the
Overall, 26 patients had urgent cholecystectomy, with acute cholecystitis confirmed by pathology in 23. The remaining 163 patients were discharged. Among 140 patients who could be reached by phone afterward, only 1 reported cholecystectomy after discharge from the emergency department.
In a February 8th online article in the Annals of Emergency Medicine, the authors report that bedside ultrasonography yielded 20 true positives, 115 true negatives, 26 false positives, and 3 false negatives, resulting in 87% sensitivity and 82% specificity.
Radiology ultrasonography yielded 19 true positives, 77 true negatives, 13 false positives, and 4 false negatives, for a sensitivity of 83% and specificity of 86%.
None of the secondary ultrasound findings (Murphy's sign, gallbladder wall thickening, or pericholecystic fluid) was sensitive enough to exclude cholecystitis either at bedside or in the radiology department, the researchers note.
"Because emergency physicians in our study tended to be highly experienced in bedside ultrasonography, our results may not be applicable to the general community or reproducible at centers without ultrasonographic training programs," the investigators caution. Use of bedside ultrasonography "in community hospitals or at academic centers without ultrasonographic fellowships" still needs to be tested, they add.
"Radiology probably should be involved if there is anything beyond nuts and bolts cholelithiasis or cholecystitis," Dr. Scruggs said.
"Emergency physician ultrasound (can) decrease CT use," he added. "A huge number of smaller emergency departments in this country don't have radiology ultrasound most of the day, but they do have a CT scanner. In those places, what study does the patient with possible cholecystitis get? Because of our training, patient expectations, and the medico-legal environment, the answer isn't none. It's a CT scan that costs the patient more money, and in a small percentage, their health or even their life."
Ann Emerg Med 2010.
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