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14-08-2011 | Surgery | Article

Bedside ultrasound aids ED abdominal pain care

Abstract

Free abstract

MedWire News: Surgeon-performed ultrasound is helpful for the majority of patients attending the emergency department (ED) with acute abdominal pain, Swedish study findings demonstrate.

The research, published in the Critical Ultrasound Journal, demonstrated benefits for bedside ultrasound in diagnostic accuracy, a reduced need for admissions and examinations, and earlier surgery for patients with peritonitis compared with standard care.

Anna Lindelius (Karolinska Institute, Stockholm) and co-workers randomly assigned 800 ED patients with abdominal pain to receive routine management with or without surgeon-performed ultrasound. The patients were matched by preliminary diagnosis on arriving at the ED and other characteristics, and final diagnosis was decided 6-8 weeks after admission.

Analysis showed that use of surgeon-performed ultrasound significantly improved diagnostic accuracy in patients aged 30-59 years, with a body mass index (BMI) greater than 25 kg/mg2, and with elevated C-reactive protein, as well as those with peritonitis or upper abdominal pain.

Moreover, ultrasound reduced the need for further radiologic examination and admission to hospital in all patient groups, including those with a preliminary diagnosis of gallbladder concrement or cholecystitis, except those with a preliminary diagnosis of appendicitis.

Among patients with nonspecific abdominal pain, affecting about half of abdominal pain patients, the rate of admission fell by a significant 14% with surgeon-performed ultrasound compared with standard care.

Among patients with peritonitis, 61% of patients who received surgeon-performed ultrasound were admitted directly for surgery from the ED compared with just 19% of those who did not.

"This may of course reduce the risk of complications due to doctor's delay," Lindelius et al comment.

Noting the lack of adverse effects for surgeon-performed ultrasound, the team concludes: "We find the method well worth consideration for implementation at the ED."

By Lynda Williams

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