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Evaluating the diagnostic accuracy of point-of-care ultrasound for cholelithiasis and cholecystitis in a canadian emergency department

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Abstract

Objectives

Cholelithiasis and cholecystitis are common conditions that frequently require patients to come to the Emergency Department (ED) and undergo diagnostic imaging. The purpose of this study was to evaluate the test characteristics of emergency physician performed point-of-care ultrasound (POCUS) to diagnose cholelithiasis and cholecystitis in a Canadian ED.

Methods

A health records review was performed on all ED patients > 17 years of age for whom POCUS was performed to diagnose cholelithiasis and cholecystitis in a Canadian academic ED over a 5-year period. The sensitivity, specificity, predictive values, and likelihood ratios were calculated. The gold standard used for diagnosis was pathology, laparoscopy, radiology-performed comprehensive ultrasonography, followed by computed tomography scans.

Results

A total of 577 patients were included in the study. The sensitivity and specificity of POCUS to diagnose cholelithiasis was 95.2% (95% CI 91.1–97.8%) and 93.1% (95% CI 90.1–95.4%). The positive and negative likelihood ratios for POCUS to diagnose cholelithiasis were found to be 14 and 0.05; the negative predictive value was 97.6% (95% CI 95.5–98.7%). The sensitivity and specificity of POCUS to diagnose cholecystitis was 67.1% (95% CI 54.9–77.9%) and 97.6% (95% CI 95.9–98.8%). The positive and negative likelihood ratios for POCUS to diagnose cholecystitis were found to be 28 and 0.34; the negative predictive value was 95.6% (95% CI 93.9–96.8%).

Conclusion

POCUS is reliable for the diagnosis of cholelithiasis and for ruling in cholecystitis. In cases where POCUS is negative or indeterminate for cholecystitis, further imaging should be obtained as clinical suspicion warrants.

Résumé

Objectifs

La cholélithiase et la cholécystite sont des troubles médicaux courants qui obligent fréquemment les patients à se rendre aux urgences et subir une imagerie diagnostique. Le but de cette étude était d'évaluer les caractéristiques des tests de l'échographie au point d’intervention (POCUS) effectuée par des médecins urgentistes pour diagnostiquer la cholélithiase et la cholécystite dans une urgence canadienne.

Méthodes

Un examen des dossiers médicaux a été effectué sur tous les patients des services d’urgence, âgés de plus de 17 ans pour lesquels POCUS a été réalisée pour diagnostiquer la cholélithiase et la cholécystite dans un service d’urgence universitaire canadien sur une période de 5 ans. La sensibilité, la spécificité, les valeurs prédictives et les rapports de vraisemblance ont été calculés. L'étalon-or utilisé pour le diagnostic était la pathologie, la laparoscopie, l'échographie complète réalisée par radiologie, suivie de la tomodensitométrie.

Résultats

Au total, 577 patients ont été inclus dans l'étude. La sensibilité et la spécificité de POCUS pour diagnostiquer la cholélithiase étaient de 95.2% (IC 95% 91.1–97.8%) et 93.1% (IC 95% 90.1–95.4%). Les rapports de vraisemblance positifs et négatifs pour POCUS pour diagnostiquer la cholélithiase se sont révélés à 14 et 0.05; la valeur prédictive négative était de 97.6% (IC à 95% 95.5–98.7%). La sensibilité et la spécificité de POCUS pour diagnostiquer la cholécystite étaient de 67,1% (IC à 95% 54.9–77.9%) et de 97.6% (IC à 95% 95.9–98.8%). Les rapports de vraisemblance positifs et négatifs pour POCUS pour diagnostiquer la cholécystite se sont révélés à 28 et 0.34; la valeur prédictive négative était de 95.6% (IC à 9.5% 93.9–96.8%).

Conclusion

POCUS est fiable pour le diagnostic de la cholélithiase et de la cholécystite. Dans les cas où le POCUS est négatif ou indéterminé pour la cholécystite, une imagerie supplémentaire doit être obtenue en cas de suspicion clinique.

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References

  1. Shaffer EA, Thomson ABR, Canadian Association of G, Canadian Association for the Study of the L. First principles of gastroenterology: the basis of disease and an approach to management. Toronto: Medicine Group; 2005.

  2. Trowbridge RL, Rutkowski NK, Shojania KG. Does this patient have acute cholecystitis? JAMA. 2003;289(1):80–6.

    Article  Google Scholar 

  3. Shea JA, Berlin JA, Escarce JJ, Clarke JR, Kinosian BP, Cabana MD, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Intern Med. 1994;154(22):2573–81.

    Article  CAS  Google Scholar 

  4. Stein JC, Jacoby VL, Vittinghoff E, Wang R, Kwan E, Reynolds T, et al. Differential use of diagnostic ultrasound in U. S. Emergency departments by time of day. West J Emerg Med. 2011;12(1):90–5.

    PubMed  PubMed Central  Google Scholar 

  5. Wilson SP, Connolly K, Lahham S, Subeh M, Fischetti C, Chiem A, et al. Point-of-care ultrasound versus radiology department pelvic ultrasound on emergency department length of stay. World J Emerg Med. 2016;7(3):178–82.

    Article  Google Scholar 

  6. Lewis D, Rang L, Kim D, Robichaud L, Kwan C, Pham C, et al. Recommendations for the use of point-of-care ultrasound (POCUS) by emergency physicians in Canada. CJEM. 2019;21(6):721–6.

    Article  Google Scholar 

  7. Worster A, Haines T. Advanced statistics: understanding medical record review (MRR) studies. Acad Emerg Med. 2004;11(2):187–92.

    Article  Google Scholar 

  8. Alobaidi M, Gupta R, Jafri SZ, Fink-Bennet DM. Current trends in imaging evaluation of acute cholecystitis. Emerg Radiol. 2004;10(5):256–8.

    Article  Google Scholar 

  9. Ross M, Brown M, McLaughlin K, Atkinson P, Thompson J, Powelson S, et al. Emergency physician-performed ultrasound to diagnose cholelithiasis: a systematic review. Acad Emerg Med. 2011;18(3):227–35.

    Article  Google Scholar 

  10. Gaspari RJ, Dickman E, Blehar D. Learning curve of bedside ultrasound of the gallbladder. J Emerg Med. 2009;37(1):51–6.

    Article  Google Scholar 

Download references

Funding

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Authors and Affiliations

  1. Department of Medicine, Division of Emergency Medicine and Critical Care, McMaster University, 237 Barton St East, 2nd Floor McMaster Wing, Room 252, Hamilton General Hospital, Hamilton, ON, L8L 2X2, Canada

    Sameer Sharif, Dean Vlahaki, Steven Skitch, Jenifer Truong & Andrew Healey

  2. Department of Medicine, Division of Critical Care, McMaster University, Hamilton, ON, Canada

    Sameer Sharif, Steven Skitch & Andrew Healey

  3. Department of Medicine, Division of Emergency Medicine, Western University, London, ON, Canada

    Shane Freeman

  4. Department of Medicine, Division of General Internal Medicine, Sunnybrook Health Sciences Centre, Toronto, ON, Canada

    Daniel Sidalak

  5. Department of Hospitalist Medicine, St. Mary’s General Hospital, Kitchener, ON, Canada

    Daniel Sidalak

Authors
  1. Sameer Sharif
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  2. Dean Vlahaki
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  3. Steven Skitch
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  4. Jenifer Truong
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  5. Shane Freeman
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  6. Daniel Sidalak
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  7. Andrew Healey
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Corresponding author

Correspondence to Sameer Sharif.

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None declared.

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Sharif, S., Vlahaki, D., Skitch, S. et al. Evaluating the diagnostic accuracy of point-of-care ultrasound for cholelithiasis and cholecystitis in a canadian emergency department. Can J Emerg Med 23, 626–630 (2021). https://doi.org/10.1007/s43678-020-00068-6

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  • DOI: https://doi.org/10.1007/s43678-020-00068-6

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