Surgeon-Performed Ultrasound in Diagnosing Acute Cholecystitis and Appendicitis

Camilla Gustafsson,Anders Sondén,Anna Lindelius,Staffan Törngren,Hans Järnbert‐Pettersson

doi:10.1007/s00268-018-4673-z

Camilla Gustafsson, Anders Sondén + Show 3 more

Open Access

https://doi.org/10.1007/s00268-018-4673-z

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Abstract

BackgroundThe use of ultrasound (US) outside the radiology department has increased the last decades, but large studies assessing the quality of bedside US are still lacking. This study evaluates surgeon-performed US (SPUS) and radiologist-performed US (RPUS) with respect to biliary disease and appendicitis.MethodsBetween October 2011 and November 2012, 300 adult patients, with a referral for an abdominal US, were prospectively enrolled in the study and examined by a radiologist as well as a surgeon. The surgeons had undergone a 4-week-long US education. US findings of the surgeon and of the radiologist were compared to final diagnosis, set by an independent external observer going through each patient’s chart.ResultsAmong 183 patients with suspected biliary disease, 74 had gallstones and 21 had acute cholecystitis. SPUS and RPUS diagnosed gallstones with a sensitivity of 87.1 versus 97.3%. Specificity was 96.0 versus 98.9%, and the accuracy 92.3 versus 98.2%. The sensitivity, specificity and accuracy for acute cholecystitis by SPUS and RPUS were: 60.0 versus 80.0%, 98.6 versus 97.8% and 93.9 versus 95.6%, respectively. Among 58 patients with suspected appendicitis, 15 had the disease. The sensitivity, specificity and accuracy for appendicitis by SPUS and RPUS were: 53.3 versus 73.3%, 89.7 versus 93.3% and 77.3 versus 86.7%, respectively.ConclusionSPUS is reliable in diagnosing gallstones. Diagnosing cholecystitis and appendicitis with US is more challenging for both surgeons and radiologists.Trial registration numberThe study was registered at clinicaltrials.gov. Registration number: NCT02469935.

Highlights

Data collectionThe use of ultrasound (US) outside the radiology department, often referred to as point-of-care ultrasound (POCUS), has increased in the last decades as more compact and portable scanners have become available [1]
surgeon-performed US (SPUS) is reliable in diagnosing gallstones
Diagnosing cholecystitis and appendicitis with US is more challenging for both surgeons and radiologists

Summary

Introduction

Data collectionThe use of ultrasound (US) outside the radiology department, often referred to as point-of-care ultrasound (POCUS), has increased in the last decades as more compact and portable scanners have become available [1]. The quality of abdominal US—in these contexts—appears to be even more operator dependent, which may have negative impact on the quality of SPUS since surgeons don’t get the same amount of US training as radiologists [11] To what extent this matters, is not known, since studies on the subject are few [12]. The aim of this study was to validate the diagnostic accuracy of SPUS regarding acute cholecystitis and appendicitis, comparing ultrasound examinations to final diagnosis. This study evaluates surgeon-performed US (SPUS) and radiologist-performed US (RPUS) with respect to biliary disease and appendicitis. The sensitivity, specificity and accuracy for acute cholecystitis by SPUS and RPUS were: 60.0 versus 80.0%, 98.6 versus 97.8% and 93.9 versus 95.6%, respectively.

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