640 Ambulatory Ultrasound - Could We Be More Efficient? Re-Audit -a District General Hospital Experience

Abstract

Abstract Aim Right iliac fossa (RIF) pain is a common presentation to General Surgery departments and appendicitis is a possible cause. There are diagnostic challenges in these patients. Over a fifth undergoing appendicectomy have a histologically normal appendix (1). National guidelines recommend performing Ultrasound Scans (USS) in select patients (2). Aim is to review if there is better use of a limited service. Method A retrospective review of all ambulatory USS from June - December 2020 comparing to data from June 2019 - December 2019 for RIF/lower abdominal pain. We collected demographics, working diagnoses, imaging request details and outcomes. Results 109 patients were included. 106 were female and 3 males. Of these, 35 had a working diagnosis of ovarian/ gynaecology pathology, whilst 25 had one of ‘appendicitis vs gynaecological pathology’. The USS was reported as no abnormality detected in 73 patients. 94(86%) had matching working diagnosis to USS request (41% in 1st audit). 22 (20%) had a working diagnosis matched with USS results (13%). In total 101 patients were discharged – there were 5 admissions (3 CT scans + 2 laparoscopic appendicectomies) and 3 referrals onwards to gynaecology. Conclusions We recommend using USS pelvis in women of childbearing age to identify gynaecological causes of RIF pain, more focused requests in order reduce requests of abdominal USS in lower abdominal pain, males should only receive hot clinic scans for biliary concerns, and increased use of CT for females >40 years old.