Diagnostic performance of abdominal point of care ultrasound performed by an emergency physician in acute right iliac fossa pain
AbstractBackgroundRight iliac fossa abdominal pain is a common reason for emergency ward admissions, its etiology is difficult to diagnose. It can be facilitated by an imaging examination, such as a Computerized Tomography scan which exposes the patient to ionizing radiation and implies delays. A bedside ultrasound performed by emergency physicians could avoid these issues. The aim of our study was to assess the performance of ultrasound carried out at the patient ’s bedside by an emergency physician compared with a clinical-laboratory examination for the diagnosis of a surgical pathology in right iliac fossa pain.MethodsThis is a single-center prospective cohort study conducted in an Emergency Department receiving 19,000 patients per year. All patients presenting pain in the right iliac fossa were included by four (out of ten) emergency physicians certified in an ultrasound examination. A full grid pattern scan ultrasound of the abdominal cavity with analysis of the right iliac fossa was performed. The primary outcome was to compare the diagnosis performance of bedside ultrasound and clinical-laboratory examination to detect a surgical pathology. Two emergency physicians who did not participate in the study made the final diagnosis (i.e., surgical or non-surgical pathology) by reviewing the entire medical chart of each patient.ResultsFrom January 2011 to July 2013, 158 patients with a median age of 17 [13 –32] years were analyzed. The diagnosed cases were: append...
ConclusionThe importance of POCUS in scanning right iliac fossa for patients present with signs and symptoms that are mimicking acute appendicitis for diagnosing a rare pathology and avoiding the risk of ionizing radiation hazards and unnecessary surgical intervention.
CONCLUSION: The strategy of repeating limited focused US followed by CT scan in cases that remain inconclusive has good diagnostic accuracy and reasonable NAR and decreases the number of CT scans. PMID: 31913249 [PubMed - as supplied by publisher]
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Authors: Altomare M, Cimbanassi S, Chiara O, Salvi PF Abstract OBJECTIVES: Evaluate Alvarado Score's (AS) accuracy related with C-reactive protein (CRP). Evaluate the accuracy rate of ultrasonography (US). MATERIALS AND METHODS: We analyzed data on 290 patients admitted to Emergency Department (ED) of Sant'Andrea Hospital (Rome - Italy) presenting abdominal pain in lower quadrants between Jan2009-Apr2015. AS, laboratory tests, images and report from CT-scan and US were collected. Histological examination is considered as Gold Standard. We calculated Specificity(Sp), Sensitivity(Se), Accuracy(Ac), positive predi...
CONCLUSION: A large randomised trial to evaluate the use of unenhanced computed tomography in atypical right iliac fossa pain appears feasible and justified. PMID: 31219315 [PubMed - as supplied by publisher]
ConclusionsDespite its rarity, it is feasible to diagnose SA using PoCUS, as patients presenting with right lower quadrant pain and history of appendectomy are at risk for delayed diagnosis, perforation, and poor outcome. PoCUS may reduce time to diagnosis, time to definitive operative or non-operative management, and minimize morbidity.
ConclusionsYoung women are particularly at risk for NA. Increasing the use of preoperative CT and incorporating imaging into the overall assessment of a patient seems to be actually the only way to reduce the incidence of NA without increasing the rates of perforation. Considering the relatively high morbidity after an NA procedure, every surgeon must carefully consider the risk –benefit balance prior to performing an appendectomy during diagnostic laparoscopy for suspected acute appendicitis showing a macroscopically noninflamed appendix.
Rationale: Acute appendicitis is one of the most common causes of acute abdomen in children, yet it is difficult to diagnose in young children because its clinical manifestations may be atypical. Here, 3 atypical clinical cases associated with appendicitis in children are reported. Patient concern: The 1st case corresponds to a 5-year-old male patient who presented with abdominal discomfort, intermittent fevers, and vomiting, have increased white blood cell (WBC) count and C-reactive protein (CRP). The second case is a 7-year-old male patient who began with intermittent fevers and lower quadrant abdominal pain, showin...
Conclusion: Although surgical intervention should be reserved for specific complications, its delay increases the incidence of NEC related mortality. Though rare, fungal infection should be suspected especially in cases with worsening signs of typhlitis despite broad antimicrobial coverage. Early management and better supportive care of underlying Co-morbid conditions can decrease NEC related mortality.DisclosuresNo relevant conflicts of interest to declare.
Condition: Abdominal Pain Interventions: Other: unenhanced abdomino-pelvic CT scan; Other: abdominal ultrasound Sponsor: South Tees Hospitals NHS Foundation Trust Completed