ORIGINAL ARTICLES

Impact of surgeon-performed ultrasound on diagnosis of abdominal pain

A Lindelius^1,2, S Törngren^1,2, A Sondén^1,2, H Pettersson¹, J Adami³

¹ Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Stockholm, Sweden
² Department of Surgery, Stockholm South General Hospital, Stockholm, Sweden
³ Karolinska Institutet, Department of Medicine, Clinical Epidemiology Unit, Stockholm, Sweden

Correspondence to:
Dr A Lindelius, Karolinska Institutet, Department of Clinical Science and Education, Södersjukhuset, Department of Surgery, Stockholm South General Hospital, Sjukhusbacken 10, 118 83 Stockholm, Sweden; anna.lindelius{at}sodersjukhuset.se

Background: A randomised study was performed to evaluate the diagnostic accuracy of surgeon-performed ultrasound in the emergency department for patients presenting with abdominal pain.

Methods: Surgeons responsible for the examination of study patients underwent 4 weeks of ultrasound training. 800 patients who were attending the emergency department for abdominal pain were randomised to undergo or not undergo surgeon-performed ultrasound as a complement to standard examination. The preliminary diagnosis made by the surgeon, with or without ultrasound, was compared with the final diagnosis made by a senior surgeon 6–8 weeks later.

Results: Diagnostic accuracy was significantly higher in the group examined with ultrasound (64.7% vs 56.8%, p = 0.027). Ultrasound proved to be helpful in making or confirming a correct diagnosis in 24.1% of cases receiving ultrasound and to contribute in 2.9%. In 22.3% of patients the diagnosis of non-specific pain was confirmed by normal findings. Ultrasound was misleading in 10.2% of cases and had no influence on the diagnosis in 40.0%.

Conclusion: For patients with acute abdominal pain, higher diagnostic accuracy is achieved when surgeons use ultrasound as a diagnostic complement to standard examination. The use of bedside ultrasound should be considered in emergency departments.

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• Lindelius, A, Torngren, S, Pettersson, H, Adami, J (2009). Role of surgeon-performed ultrasound on further management of patients with acute abdominal pain: a randomised controlled clinical trial. Emerg. Med. J. 26: 561-566 [Abstract] [Full Text]