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24-10-2022 | Cholecystitis | Original Article

The use of additional imaging studies after biliary point-of-care ultrasound in the emergency department

Authors: Tony Zitek, Stephanie Fernandez, Mark A. Newberry, Roman Montes De Oca, David Kinas, Tarang Kheradia, David A. Farcy

Published in: Emergency Radiology | Issue 1/2023

Abstract

Purpose

We sought to determine the test characteristics of biliary point-of-care ultrasound (POCUS) and to assess the usefulness of obtaining radiology ultrasound (RUS) or cholescintigraphy (HIDA) after biliary POCUS.

Methods

We conducted a retrospective review of emergency department patients who underwent biliary POCUS between May 4, 2018 and November 28, 2021. To be included, patients had to have at least one of the following confirmatory evaluations (considered in this order): surgery, HIDA, RUS, or abdominal CT scan. When a discrepancy existed between the POCUS and the RUS or HIDA, they were compared to a higher criterion standard (if available).

Results

Using 348 patients who had a confirmatory evaluation after biliary POCUS, we found the sensitivity and specificity of biliary POCUS for gallstones to be 97.0% (95% CI 92.6 to 99.2%) and 99.5% (95% CI 97.3 to 100%), respectively. For cholecystitis, the sensitivity and specificity were 83.8% (95% CI 72.9 to 91.6%) and 98.6% (95% CI 96.4 to 99.6%), respectively. RUS and POCUS were concordant in 72 (81.8%) of 88 cases in which the patient had both studies while HIDA and POCUS were concordant in 24 (70.6%) of 34 cases. POCUS was deemed correct in at least 50% of discrepant cases with RUS and at least 30% of discrepant cases with HIDA.

Conclusion

Biliary POCUS has excellent sensitivity and specificity for cholelithiasis; it has lower sensitivity for cholecystitis, but the specificity remains high. Performing a confirmatory RUS or cholescintigraphy after a positive biliary POCUS adds little value, but additional imaging may be useful when POCUS is negative for cholecystitis.

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Title: The use of additional imaging studies after biliary point-of-care ultrasound in the emergency department
Authors: Tony Zitek
Stephanie Fernandez
Mark A. Newberry
Roman Montes De Oca
David Kinas
Tarang Kheradia
David A. Farcy
Publication date: 24-10-2022
Publisher: Springer International Publishing
Keywords: Cholecystitis
Ultrasound
Emergency Medicine
Cholecystectomy
Care
Ultrasound
Cholelithiasis
Published in: Emergency Radiology / Issue 1/2023
Print ISSN: 1070-3004
Electronic ISSN: 1438-1435
DOI: https://doi.org/10.1007/s10140-022-02095-5

Keynote webinar | Spotlight on medication adherence

Springer Medicine

The use of additional imaging studies after biliary point-of-care ultrasound in the emergency department

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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