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Thom C, Nomura J. Ultrasound Administration and Reimbursement. Emerg Med Clin North Am 2024; 42:967-980. [PMID: 39326997 DOI: 10.1016/j.emc.2024.05.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
One cannot successfully employ point-of-care ultrasound (POCUS) without a process to provide support and guidance. POCUS administration is a multifaceted topic that demands the utmost attention from those responsible for program implementation and long-term execution. This article delves into POCUS administration and is meant to serve as a guide for the practitioner seeking to start, maintain, or augment their POCUS program.
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Affiliation(s)
- Christopher Thom
- UVA Department of Emergency Medicine, University of Virginia Health System, PO Box 800699, Charlottesville, VA 22908, USA.
| | - Jason Nomura
- Department of Emergency Medicine, Christiana Care Health System, 4755 Ogletown Stanton Road, Newark, DE 19718, USA
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2
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Fong T, Heverling H, Rhyne R. Common Ultrasound-Guided Procedures. Emerg Med Clin North Am 2024; 42:927-945. [PMID: 39326995 DOI: 10.1016/j.emc.2024.05.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Ultrasound guidance is fundamental to procedural safety and success. For many emergency department (ED) procedures, the use of ultrasound improves first-pass success rate, time-to-completion, and complication rate when compared with traditional landmark-based techniques. Once learned, the general principles of ultrasound guidance may be adapted across a broad range of bedside procedures.
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Affiliation(s)
- Tiffany Fong
- Division of Emergency Ultrasound, Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287, USA.
| | - Harry Heverling
- Division of Emergency Ultrasound, Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287, USA
| | - Randall Rhyne
- Division of Emergency Ultrasound, Department of Emergency Medicine, Johns Hopkins University School of Medicine, 1830 East Monument Street, Suite 6-100, Baltimore, MD 21287, USA
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3
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Salerno A, Gottlieb M. Point-of-Care Ultrasound in the Emergency Department: Past, Present, and Future. Emerg Med Clin North Am 2024; 42:xvii-xxi. [PMID: 39327000 DOI: 10.1016/j.emc.2024.05.016] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Affiliation(s)
- Alexis Salerno
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, MD, USA.
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA.
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4
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Alerhand S, Adrian RJ, Taylor LA. Cardiac Point-Of-Care Ultrasound: An Emergency Medicine Review. Emerg Med Clin North Am 2024; 42:731-754. [PMID: 39326985 DOI: 10.1016/j.emc.2024.05.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Cardiac point-of-care ultrasound (POCUS) can make critical diagnoses and monitor the response to interventions. In contrast with consultative echocardiography, cardiac POCUS serves to answer a specific clinical question. This imaging modality can be used to evaluate for left ventricular systolic and diastolic dysfunction, pericardial effusion and tamponade, acute and chronic right ventricular dysfunction, valvular dysfunction, and cardiac activity in cardiac arrest.
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Affiliation(s)
- Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School; 150 Bergen Street, Newark, NJ 07042, USA.
| | - Robert James Adrian
- Department of Emergency Medicine, Christchurch Hospital, 2 Riccarton Avenue, Christchurch Central City, Christchurch 8011, New Zealand
| | - Lindsay Anne Taylor
- Department of Emergency Medicine, Virginia Commonwealth University Health System, 1250 East Marshall Street, Richmond, VA 23298, USA
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5
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Shibata J, Liu YT. Clinical Ultrasound in Obstetrics and Gynecology. Emerg Med Clin North Am 2024; 42:839-862. [PMID: 39326991 DOI: 10.1016/j.emc.2024.05.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/28/2024]
Abstract
Point-of-care ultrasound is a useful tool in the evaluation of women with pelvic complaints in the emergency department. Transabdominal and transvaginal approaches may be employed to assess a variety of obstetric or gynecologic pathologies.
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Affiliation(s)
- Jackie Shibata
- Department of Emergency Medicine, Olive View-UCLA Medical Center, Los Angeles, CA, USA. https://twitter.com/jackieshibata
| | - Yiju Teresa Liu
- Department of Emergency Medicine, Harbor-UCLA Medical Center, Los Angeles, CA, USA.
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Kim DJ, Sheppard G, Lewis D, Buchanan IM, Jelic T, Thavanathan R, Myslik F, Lalande E, Bell CR, Chenkin J, Heslop CL, Olszynski P, Atkinson P, Burwash-Brennan T. POCUS literature primer: key papers on cardiac and lung POCUS. CAN J EMERG MED 2024:10.1007/s43678-024-00755-8. [PMID: 39183217 DOI: 10.1007/s43678-024-00755-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2024] [Accepted: 07/26/2024] [Indexed: 08/27/2024]
Abstract
OBJECTIVE Although point of care ultrasound (POCUS) use has become prevalent in medicine, clinicians may not be familiar with the evidence supporting its utility in patient care. The objective of this study is to identify the top five most influential papers published on the use of cardiac POCUS and lung POCUS in adult patients. METHODS A 14-member expert panel from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative used a modified Delphi process. Panel members are ultrasound fellowship trained or equivalent, are engaged in POCUS scholarship, and are leaders in POCUS locally and nationally in Canada. The modified Delphi process consisted of three rounds of sequential surveys and discussion to achieve consensus on the top five most influential papers on cardiac POCUS and lung POCUS. RESULTS A total of 66 relevant papers on cardiac POCUS and 68 relevant papers on lung POCUS were nominated by the panel. There was 100% participation by the panel members in all three rounds of the modified Delphi process. At the end of this process, we identified the top five most influential papers on cardiac POCUS and lung POCUS. Papers include studies supporting the use of POCUS for accurately assessing left ventricular systolic function, diagnosing pericardial effusion, clarifying its test characteristics for pulmonary embolism, identifying pulmonary edema and pneumonia, as well as consensus statements on the use of cardiac and lung POCUS in clinical practice. CONCLUSION We have created a list of the top five influential papers on cardiac POCUS and lung POCUS as an evidence-based resource for trainees, clinicians, and researchers. This will help trainees and clinicians better understand how to use POCUS when scanning the heart and lungs, and it will also help researchers better understand where to direct their scholarly efforts with future research.
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Affiliation(s)
- Daniel J Kim
- Department of Emergency Medicine, University of British Columbia and Vancouver General Hospital, Vancouver, BC, Canada.
| | - Gillian Sheppard
- Discipline of Emergency Medicine, Memorial University of Newfoundland, St. John's, NF, Canada
| | - David Lewis
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Ian M Buchanan
- Division of Emergency Medicine, Department of Medicine, McMaster University, Hamilton, ON, Canada
| | - Tomislav Jelic
- Department of Emergency Medicine, University of Manitoba, Winnipeg, MB, Canada
| | - Rajiv Thavanathan
- Ottawa Hospital Research Institute and Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Frank Myslik
- Division of Emergency Medicine, Department of Medicine, Western University, London, ON, Canada
| | - Elizabeth Lalande
- Department of Emergency Medicine, Université Laval, Quebec City, QC, Canada
| | - Colin R Bell
- Department of Emergency Medicine, University of Calgary, Calgary, AB, Canada
| | - Jordan Chenkin
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Claire L Heslop
- Division of Emergency Medicine, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, SK, Canada
| | - Paul Atkinson
- Department of Emergency Medicine, Dalhousie Medicine New Brunswick, Saint John, NB, Canada
| | - Talia Burwash-Brennan
- Department of Family and Emergency Medicine, Université de Montréal, Montreal, QC, Canada
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Alpert EA, Gold DD, Kobliner-Friedman D, Wagner M, Dadon Z. Revolutionizing Bladder Health: Artificial-Intelligence-Powered Automatic Measurement of Bladder Volume Using Two-Dimensional Ultrasound. Diagnostics (Basel) 2024; 14:1829. [PMID: 39202317 PMCID: PMC11353831 DOI: 10.3390/diagnostics14161829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2024] [Revised: 08/12/2024] [Accepted: 08/14/2024] [Indexed: 09/03/2024] Open
Abstract
INTRODUCTION Measuring elevated post-void residual volume is important for diagnosing urinary outflow tract obstruction and cauda equina syndrome. Catheter placement is exact but painful, invasive, and may cause infection, whereas an ultrasound is accurate, painless, and safe. AIM The purpose of this single-center study is to evaluate the accuracy of a module for artificial-intelligence (AI)-based fully automated bladder volume (BV) prospective measurement using two-dimensional ultrasound images, as compared with manual measurement by expert sonographers. METHODS Pairs of transverse and longitudinal bladder images were obtained from patients evaluated in an urgent care clinic. The scans were prospectively analyzed by the automated module using the prolate ellipsoid method. The same examinations were manually measured by a blinded expert sonographer. The two methods were compared using the Pearson correlation, kappa coefficients, and the Bland-Altman method. RESULTS A total of 111 pairs of transverse and longitudinal views were included. A very strong correlation was found between the manual BV measurements and the AI-based module with r = 0.97 [95% CI: 0.96-0.98]. The specificity and sensitivity for the diagnosis of an elevated post-void residual volume using a threshold ≥200 mL were 1.00 and 0.82, respectively. An almost-perfect agreement between manual and automated methods was obtained (kappa = 0.85). Perfect reproducibility was found for both inter- and intra-observer agreements. CONCLUSION This AI-based module provides an accurate automated measurement of the BV based on ultrasound images. This novel method demonstrates a very strong correlation with the gold standard, making it a potentially valuable decision-support tool for non-experts in acute settings.
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Affiliation(s)
- Evan Avraham Alpert
- Department of Emergency Medicine, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9112001, Israel; (E.A.A.)
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - Daniel David Gold
- Department of Emergency Medicine, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9112001, Israel; (E.A.A.)
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
| | - Deganit Kobliner-Friedman
- Department of Emergency Medicine, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9112001, Israel; (E.A.A.)
| | - Michael Wagner
- Division of Hospital Medicine, Department of Medicine, Prisma Health Greenville Memorial Hospital, 701 Grove Rd, Greenville, SC 29605, USA
| | - Ziv Dadon
- Faculty of Medicine, Hebrew University of Jerusalem, Jerusalem 9190500, Israel
- Jesselson Integrated Heart Center, Eisenberg R&D Authority, Shaare Zedek Medical Center, Jerusalem 9112001, Israel
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Musolino AM, Tei M, De Rose C, Buonsenso D, Supino MC, Zampogna S, Staiano A, Raponi M, Amendolea A, Colacino V, Gori L, Manganaro A, Ricci R, D'Inzeo V, Grosso S, Villani A, Agostiniani R. Pediatric ultrasound practice in Italy: an exploratory survey. Ital J Pediatr 2024; 50:114. [PMID: 38853266 PMCID: PMC11163714 DOI: 10.1186/s13052-024-01680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The aim of this exploratory survey is to describe the current state of US (ultrasound) technique across different pediatric settings nationwide. METHODS A questionnaire was emailed to all members of the Italian Society of Pediatrics, including pediatric residents. The survey was open from December 2021 to March 2022. RESULTS There were 1098 respondents. Seven hundred and seven pediatricians (84.1%) reported any use of US, while 51 (44.3%) residents denied it. The majority of participants (n = 956, 87.1%) reported to have a US machine available within the department, mostly cart-based (n = 516, 66.9%) and provided from 1 to 5 years prior to the survey (n = 330, 42.8%). Lung and neonatal cerebral regions were the most frequently scanned (n = 289, 18.7% and n = 218, 14.1%, respectively). The suspicion of pneumonia or respiratory distress represented the main reasons for performing US in emergency room (n = 390, 78% and n = 330, 66%, respectively). The majority of family pediatricians reported to scan lung and kidney/urinary tract regions (n = 30, 16.9%, and n = 23,12.9%, respectively). Regarding US training, the majority of respondents (n = 358, 34.6%) declared an experience-based education, with a deficient certification enabling the use of US in 71.6% (n = 552) of cases. The most common barriers included the lack of a well-defined training program (n = 627, 57.1%), unavailability of the US machine (n = 196, 17.9%) and legal responsibility concern (n = 175, 15.9%). CONCLUSIONS Despite the growing interest on pediatric US nationally, significant barriers still limit widespread adoption. These obstacles may be addressed through the dissemination of a specific US education plan and providing additional resources.
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Affiliation(s)
- Anna Maria Musolino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Monica Tei
- Clinical Pediatrics, Department of Mother and Child, Siena University Hospital, Viale Bracci 16, Siena, 53100, Italy.
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Stefania Zampogna
- Department Pediatrics, Hospital of Crotone President of SIMEUP (Italian Society of Pediatric Emergency Medicine Urgency), Crotone, Italy
| | - Annamaria Staiano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", President of SIP (Italian Society of Pediatric), Naples, Italy
| | - Massimiliano Raponi
- Management and Diagnostic Innovations and Clinical Pathways Research Area, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, 00165, Italy
| | | | | | - Laura Gori
- Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, 56100, Italy
| | - Alessandro Manganaro
- Pathology and Neonatal and Pediatric Intensive Care Unit, University Hospital G. Martino, Messina, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Victoria D'Inzeo
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Mother and Child, Siena University Hospital, Viale Bracci 16, Siena, 53100, Italy
| | - Alberto Villani
- Unit of General Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Rino Agostiniani
- Department of Pediatrics and Neonatology, San Jacopo Hospital, Via Ciliegiole 97, 51100, Pistoia, Italy
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Gottlieb M, Bobitt J, Kotini‐Shah P, Khosla S, Watson DP. Incorporating implementation science principles into curricular design. AEM EDUCATION AND TRAINING 2024; 8:e10996. [PMID: 38808130 PMCID: PMC11129323 DOI: 10.1002/aet2.10996] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/25/2024] [Revised: 05/06/2024] [Accepted: 05/09/2024] [Indexed: 05/30/2024]
Abstract
Implementation science (IS) is an approach focused on increasing the application of evidence-based health interventions into practice, through purposive and thoughtful planning to maximize uptake, scalability, and sustainability. Many of these principles can be readily applied to medical education, to help augment traditional approaches to curriculum design. In this paper, we summarize key components of IS with an emphasis on application to the medical educator.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency MedicineRush University Medical CenterChicagoIllinoisUSA
| | - Julie Bobitt
- Center for Dissemination and Implementation Science, Department of MedicineUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Pavitra Kotini‐Shah
- Department of Emergency MedicineUniversity of Illinois ChicagoChicagoIllinoisUSA
| | - Shaveta Khosla
- Department of Emergency MedicineUniversity of Illinois ChicagoChicagoIllinoisUSA
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Oto B, Baeten R, Chen L, Dalal P, Dancel R, Fox S, Lange IV CW, Baston C, Bornemann P, Dugar S, Goldsmith A, Herbst MK, Kirkpatrick JN, Koratala A, Lanspa MJ, Lobo V, Nomura JT, Pustavoitau A, Senussi MH, Sorrell VL, West FM, Sarwal A. Best Practices for Point of Care Ultrasound: An Interdisciplinary Expert Consensus. POCUS JOURNAL 2024; 9:95-108. [PMID: 38681157 PMCID: PMC11044939 DOI: 10.24908/pocus.v9i1.17240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Despite the growing use of point of care ultrasound (POCUS) in contemporary medical practice and the existence of clinical guidelines addressing its specific applications, there remains a lack of standardization and agreement on optimal practices for several areas of POCUS use. The Society of Point of Care Ultrasound (SPOCUS) formed a working group in 2022 to establish a set of recommended best practices for POCUS, applicable to clinicians regardless of their training, specialty, resource setting, or scope of practice. Using a three-round modified Delphi process, a multi-disciplinary panel of 22 POCUS experts based in the United States reached consensus on 57 statements in domains including: (1) The definition and clinical role of POCUS; (2) Training pathways; (3) Credentialing; (4) Cleaning and maintenance of POCUS devices; (5) Consent and education; (6) Security, storage, and sharing of POCUS studies; (7) Uploading, archiving, and reviewing POCUS studies; and (8) Documenting POCUS studies. The consensus statements are provided here. While not intended to establish a standard of care or supersede more targeted guidelines, this document may serve as a useful baseline to guide clinicians, leaders, and systems considering initiation or enhancement of POCUS programs.
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Affiliation(s)
- Brandon Oto
- Bridgeport Hospital, Yale New Haven HealthBridgeport, CTUSA
| | | | - Leon Chen
- Memorial Sloan Kettering Cancer CenterNew York, NYUSA
| | | | - Ria Dancel
- University of North Carolina at Chapel HillChapel Hill, NCUSA
| | - Steven Fox
- University of Alabama at BirminghamBirmingham, ALUSA
| | | | | | | | | | | | | | | | | | - Michael J Lanspa
- Intermountain Medical Center and the University of UtahMurray , UTUSA
| | - Viveta Lobo
- Stanford University School of MedicineStanford, CAUSA
| | | | | | | | - Vincent L. Sorrell
- Gill Heart and Vascular Institute, University of KentuckyLexington, KYUSA
| | | | - Aarti Sarwal
- Wake Forest University School of MedicineWinston-Salem, NCUSA
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Bronshteyn YS, Hashmi N, Privratsky JR, Barbeito A. Blood or Fat? Differentiating Hemopericardium versus Epicardial Fat Using Focused Cardiac Ultrasound. Diagnostics (Basel) 2024; 14:818. [PMID: 38667464 PMCID: PMC11049036 DOI: 10.3390/diagnostics14080818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2024] [Revised: 04/10/2024] [Accepted: 04/11/2024] [Indexed: 04/28/2024] Open
Abstract
Basic point-of-care ultrasound of the heart-also known as Focused Cardiac Ultrasound (FoCUS)-has emerged as a powerful bedside tool to narrow the differential diagnosis of causes of hypotension. The list of causes of hypotension that a FoCUS provider is expected to be able to recognize includes a compressive pericardial effusion due to hemopericardium (blood in the pericardial sac). But hemopericardium can be difficult to distinguish from a more common condition that is not immediately life-threatening: epicardial fat. This paper reviews illustrative images of both epicardial fat and hemopericardium to provide practice guidance to the FoCUS user on how to differentiate these two phenomena.
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Affiliation(s)
- Yuriy S. Bronshteyn
- Duke University Health System, Duke University School of Medicine, Durham, NC 27710, USA
- Durham Veterans Health Administration, Durham, NC 27705, USA
| | - Nazish Hashmi
- Duke University Health System, Duke University School of Medicine, Durham, NC 27710, USA
| | - Jamie R. Privratsky
- Duke University Health System, Duke University School of Medicine, Durham, NC 27710, USA
| | - Atilio Barbeito
- Duke University Health System, Duke University School of Medicine, Durham, NC 27710, USA
- Durham Veterans Health Administration, Durham, NC 27705, USA
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Gottlieb M. SPEED of sound: The role of ultrasound in aortic dissection. Acad Emerg Med 2024; 31:201-203. [PMID: 38375964 DOI: 10.1111/acem.14885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2023] [Revised: 01/14/2024] [Accepted: 01/31/2024] [Indexed: 02/21/2024]
Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, Illinois, USA
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13
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Huang SS, Lin KW, Liu KL, Wu YM, Lien WC, Wang HP. Diagnostic performance of ultrasound in acute cholecystitis: a systematic review and meta-analysis. World J Emerg Surg 2023; 18:54. [PMID: 38037062 PMCID: PMC10687940 DOI: 10.1186/s13017-023-00524-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2023] [Accepted: 11/25/2023] [Indexed: 12/02/2023] Open
Abstract
BACKGROUND An updated overview of ultrasound (US) for diagnosis of acute cholecystitis (AC) remains lacking. This systematic review was conducted to evaluate the diagnostic performance of US for AC. METHODS A systematic review was conducted following PRISMA guidelines. We meticulously screened articles from MEDLINE, Embase, and the Cochrane Library, spanning from inception to August 2023. We employed the search strategy combining the keywords "bedside US", "emergency US" or "point-of-care US" with "AC". Two reviewers independently screened the titles and abstracts of the retrieved articles to identify suitable studies. The inclusion criteria encompassed articles investigating the diagnostic performance of US for AC. Data regarding diagnostic performance, sonographers, and sonographic findings including the presence of gallstone, gallbladder (GB) wall thickness, peri-GB fluid, or sonographic Murphy sign were extracted, and a meta-analysis was executed. Case reports, editorials, and review articles were excluded, as well as studies focused on acalculous cholecystitis. The study quality was assessed with the Quality Assessment of Diagnostic Accuracy Studies-2 (QUADAS-2) tool. RESULTS Forty studies with 8,652 patients were included. The majority of studies had a low risk of bias and applicability concerns. US had a pooled sensitivity of 71% (95% CI, 69-72%), a specificity of 85% (95% CI, 84-86%), and an accuracy of 0.83 (95% CI, 0.82-0.83) for the diagnosis of AC. The pooled sensitivity and specificity were 71% (95% CI, 67-74%) and 92% (95% CI, 90-93%) performed by emergency physicians (EPs), 79% (95% CI, 71-85%) and 76% (95% CI, 69-81%) performed by surgeons, and 68% (95% CI 66-71%) and 87% (95% CI, 86-88%) performed by radiologists, respectively. There were no statistically significant differences among the three groups. CONCLUSION US is a good imaging modality for the diagnosis of AC. EP-performed US has a similar diagnostic performance to radiologist-performed US. Further investigations would be needed to investigate the impact of US on expediting the management process and improving patient-centered outcomes.
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Affiliation(s)
- Sih-Shiang Huang
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Kai-Wei Lin
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan
| | - Kao-Lang Liu
- Department of Medical Imaging, National Taiwan University Cancer Center, National Taiwan University Hospital, Taipei, Taiwan
- Department of Medical Imaging, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Yao-Ming Wu
- Department of Surgery, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Wan-Ching Lien
- Department of Emergency Medicine, National Taiwan University Hospital and College of Medicine, National Taiwan University, No.7, Chung-Shan South Road, Taipei, 100, Taiwan.
- Department of Emergency Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.
| | - Hsiu-Po Wang
- Department of Internal Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan
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