The Accuracy of Point-of-Care Ultrasound (POCUS) in Acute Gallbladder Disease
There is increasing recognition that point-of-care ultrasound (POCUS), performed by the clinician at the bedside, can be a natural extension of the clinical examination—the modern abdominal “stethoscope” and provides an opportunity to expedite the care pathway for patients with acute gallbladder dis...
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
MDPI AG
2023-03-01
|
| Series: | Diagnostics |
| Subjects: | |
| Online Access: | https://www.mdpi.com/2075-4418/13/7/1248 |
| _version_ | 1797608169964306432 |
|---|---|
| author | Bogdan-Daniel Dumbrava Gary Alan Bass Amro Jumean Nuha Birido Martin Corbally Jorge Pereira Alan Biloslavo Mauro Zago Thomas Noel Walsh |
| author_facet | Bogdan-Daniel Dumbrava Gary Alan Bass Amro Jumean Nuha Birido Martin Corbally Jorge Pereira Alan Biloslavo Mauro Zago Thomas Noel Walsh |
| author_sort | Bogdan-Daniel Dumbrava |
| collection | DOAJ |
| description | There is increasing recognition that point-of-care ultrasound (POCUS), performed by the clinician at the bedside, can be a natural extension of the clinical examination—the modern abdominal “stethoscope” and provides an opportunity to expedite the care pathway for patients with acute gallbladder disease. The primary aims of this study were to benchmark the accuracy of surgeon-performed POCUS in suspected acute gallbladder disease against standard radiology or pathology reports and to compare time to POCUS diagnosis with time to definitive imaging. This prospective single-arm observational cohort study was conducted in four hospitals in Ireland, Italy, and Portugal to assess the accuracy of POCUS against standard radiology in patients with suspected acute biliary disease (ClinicalTrials.govIdentifier: NCT02682368). The findings of surgeon-performed POCUS were compared with those on definitive imaging or surgery. Of 100 patients recruited, 89 were suitable for comparative analysis, comparing POCUS with radiological findings in 84 patients and with surgical/histological findings in five. The overall global accuracy of POCUS was 88.7% (95% CI, 80.3–94.4%), with a sensitivity of 94.7% (95% CI, 85.3–98.9%), a specificity of 78.1% (95% CI, 60.03–90.7%), a positive likelihood ratio (LR+) of 4.33 and negative likelihood ratio (LR) of 0.07. The mean time from POCUS to the final radiological report was 11.9 h (range 0.06–54.9). In five patients admitted directly to surgery, the mean time between POCUS and incision was 2.30 h (range 1.5–5), which was significantly shorter than the mean time to formal radiology report. Sixteen patients were discharged from the emergency department, of whom nine did not need follow-up. Our study is one of the very few to demonstrate a high concordance between surgeon-performed POCUS of patients without a priori radiologic diagnosis of gallstone disease and shows that the expedited diagnosis afforded by POCUS can be reliably leveraged to deliver earlier definitive care for patients with acute gallbladder pathology, as the general surgeon skilled in POCUS is uniquely positioned to integrate it into their bedside assessment. |
| first_indexed | 2024-03-11T05:39:39Z |
| format | Article |
| id | doaj.art-3ab5ea50ea9c4e3bae258f16c0f093d2 |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T05:39:39Z |
| publishDate | 2023-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-3ab5ea50ea9c4e3bae258f16c0f093d22023-11-17T16:29:55ZengMDPI AGDiagnostics2075-44182023-03-01137124810.3390/diagnostics13071248The Accuracy of Point-of-Care Ultrasound (POCUS) in Acute Gallbladder DiseaseBogdan-Daniel Dumbrava0Gary Alan Bass1Amro Jumean2Nuha Birido3Martin Corbally4Jorge Pereira5Alan Biloslavo6Mauro Zago7Thomas Noel Walsh8Department of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, D02 YN77 Dublin, IrelandDepartment of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, D02 YN77 Dublin, IrelandDepartment of Surgery, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 15503, BahrainDepartment of Surgery, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 15503, BahrainDepartment of Surgery, Royal College of Surgeons in Ireland, Medical University of Bahrain, Busaiteen 15503, BahrainDepartment of Surgery, Tondela-Viseu Hospital Center, Av. Rei Dom Duarte, 3504-509 Viseu, PortugalDepartment of Surgery, Cattinara University Hospital, Strada di Fiume 447, 34149 Trieste, ItalyDepartment of Surgery, Policlinico San Pietro, Via Carlo Forlanini 15, 24036 Ponte San Pietro, ItalyDepartment of Surgery, Royal College of Surgeons in Ireland, Connolly Hospital, Blanchardstown, D02 YN77 Dublin, IrelandThere is increasing recognition that point-of-care ultrasound (POCUS), performed by the clinician at the bedside, can be a natural extension of the clinical examination—the modern abdominal “stethoscope” and provides an opportunity to expedite the care pathway for patients with acute gallbladder disease. The primary aims of this study were to benchmark the accuracy of surgeon-performed POCUS in suspected acute gallbladder disease against standard radiology or pathology reports and to compare time to POCUS diagnosis with time to definitive imaging. This prospective single-arm observational cohort study was conducted in four hospitals in Ireland, Italy, and Portugal to assess the accuracy of POCUS against standard radiology in patients with suspected acute biliary disease (ClinicalTrials.govIdentifier: NCT02682368). The findings of surgeon-performed POCUS were compared with those on definitive imaging or surgery. Of 100 patients recruited, 89 were suitable for comparative analysis, comparing POCUS with radiological findings in 84 patients and with surgical/histological findings in five. The overall global accuracy of POCUS was 88.7% (95% CI, 80.3–94.4%), with a sensitivity of 94.7% (95% CI, 85.3–98.9%), a specificity of 78.1% (95% CI, 60.03–90.7%), a positive likelihood ratio (LR+) of 4.33 and negative likelihood ratio (LR) of 0.07. The mean time from POCUS to the final radiological report was 11.9 h (range 0.06–54.9). In five patients admitted directly to surgery, the mean time between POCUS and incision was 2.30 h (range 1.5–5), which was significantly shorter than the mean time to formal radiology report. Sixteen patients were discharged from the emergency department, of whom nine did not need follow-up. Our study is one of the very few to demonstrate a high concordance between surgeon-performed POCUS of patients without a priori radiologic diagnosis of gallstone disease and shows that the expedited diagnosis afforded by POCUS can be reliably leveraged to deliver earlier definitive care for patients with acute gallbladder pathology, as the general surgeon skilled in POCUS is uniquely positioned to integrate it into their bedside assessment.https://www.mdpi.com/2075-4418/13/7/1248point-of-carecholecystitischolecystectomyultrasonographygallbladder |
| spellingShingle | Bogdan-Daniel Dumbrava Gary Alan Bass Amro Jumean Nuha Birido Martin Corbally Jorge Pereira Alan Biloslavo Mauro Zago Thomas Noel Walsh The Accuracy of Point-of-Care Ultrasound (POCUS) in Acute Gallbladder Disease Diagnostics point-of-care cholecystitis cholecystectomy ultrasonography gallbladder |
| title | The Accuracy of Point-of-Care Ultrasound (POCUS) in Acute Gallbladder Disease |
| title_full | The Accuracy of Point-of-Care Ultrasound (POCUS) in Acute Gallbladder Disease |
| title_fullStr | The Accuracy of Point-of-Care Ultrasound (POCUS) in Acute Gallbladder Disease |
| title_full_unstemmed | The Accuracy of Point-of-Care Ultrasound (POCUS) in Acute Gallbladder Disease |
| title_short | The Accuracy of Point-of-Care Ultrasound (POCUS) in Acute Gallbladder Disease |
| title_sort | accuracy of point of care ultrasound pocus in acute gallbladder disease |
| topic | point-of-care cholecystitis cholecystectomy ultrasonography gallbladder |
| url | https://www.mdpi.com/2075-4418/13/7/1248 |
| work_keys_str_mv | AT bogdandanieldumbrava theaccuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT garyalanbass theaccuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT amrojumean theaccuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT nuhabirido theaccuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT martincorbally theaccuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT jorgepereira theaccuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT alanbiloslavo theaccuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT maurozago theaccuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT thomasnoelwalsh theaccuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT bogdandanieldumbrava accuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT garyalanbass accuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT amrojumean accuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT nuhabirido accuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT martincorbally accuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT jorgepereira accuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT alanbiloslavo accuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT maurozago accuracyofpointofcareultrasoundpocusinacutegallbladderdisease AT thomasnoelwalsh accuracyofpointofcareultrasoundpocusinacutegallbladderdisease |