Presentation Title

Suspected Small Bowel Obstruction in the Emergency Department: Accuracy of Point-of-Care Ultrasound

Start Date

November 2016

End Date

November 2016

Location

Surge 172

Type of Presentation

Oral Talk

Abstract

The current procedure for evaluating the presence of a small bowel obstruction (SBO) in emergency department patients is an abdominal x-ray (AXR) followed by computed tomography (CT) imaging if the x-ray is insufficient. Although accurate, these methods are time consuming, costly, and expose patients to potentially harmful radiation. This study proposes the use of point-of-care ultrasound (POCUS) instead, seeking to evaluate its accuracy in diagnosing SBO in ED patients. A prospective observational study, it was conducted at three different hospitals, with a blinded emergency physician performing the ultrasound on the patient. Results of the ultrasound and x-ray were compared with the CT and discharge diagnosis. Sensitivity, specificity, and likelihood ratios (LR) were calculated for both POCUS and AXR. Of the 148 patients enrolled, 102 received an ultrasound. Overall prevalence of SBO was 52.7%. POCUS demonstrated an overall sensitivity of 88.5% [95% CI, 79.2-94.6%], specificity of 50.0% [37.8-62.2%], +LR of 1.77 [1.38-2.27] and –LR of 0.23 [0.12-0.45] for the diagnosis of SBO. “To-and-fro” peristalsis (76.9% [66.0-85.7%]) and small bowel diameter > 25 mm (75.6% [64.6-84.7%]) were the most sensitive findings. The presence of a transition point was the most specific finding (96.6% [88.1-99.6%]) and was seen in 23 cases. AXR was performed in a subset of 59 patients and demonstrated a sensitivity of 72.5% [56.1-85.4%], specificity of 79.0% [54.4-94.0%], +LR of 3.44 [1.41-8.40] and –LR of 0.35 [0.20-0.61] with a SBO prevalence of 70.0%. Overall, while POCUS is more sensitive than AXR in the diagnosis of SBO, it is not as specific. Also, SBO is more likely if there is an identifiable transition point.

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Nov 12th, 2:45 PM Nov 12th, 3:00 PM

Suspected Small Bowel Obstruction in the Emergency Department: Accuracy of Point-of-Care Ultrasound

Surge 172

The current procedure for evaluating the presence of a small bowel obstruction (SBO) in emergency department patients is an abdominal x-ray (AXR) followed by computed tomography (CT) imaging if the x-ray is insufficient. Although accurate, these methods are time consuming, costly, and expose patients to potentially harmful radiation. This study proposes the use of point-of-care ultrasound (POCUS) instead, seeking to evaluate its accuracy in diagnosing SBO in ED patients. A prospective observational study, it was conducted at three different hospitals, with a blinded emergency physician performing the ultrasound on the patient. Results of the ultrasound and x-ray were compared with the CT and discharge diagnosis. Sensitivity, specificity, and likelihood ratios (LR) were calculated for both POCUS and AXR. Of the 148 patients enrolled, 102 received an ultrasound. Overall prevalence of SBO was 52.7%. POCUS demonstrated an overall sensitivity of 88.5% [95% CI, 79.2-94.6%], specificity of 50.0% [37.8-62.2%], +LR of 1.77 [1.38-2.27] and –LR of 0.23 [0.12-0.45] for the diagnosis of SBO. “To-and-fro” peristalsis (76.9% [66.0-85.7%]) and small bowel diameter > 25 mm (75.6% [64.6-84.7%]) were the most sensitive findings. The presence of a transition point was the most specific finding (96.6% [88.1-99.6%]) and was seen in 23 cases. AXR was performed in a subset of 59 patients and demonstrated a sensitivity of 72.5% [56.1-85.4%], specificity of 79.0% [54.4-94.0%], +LR of 3.44 [1.41-8.40] and –LR of 0.35 [0.20-0.61] with a SBO prevalence of 70.0%. Overall, while POCUS is more sensitive than AXR in the diagnosis of SBO, it is not as specific. Also, SBO is more likely if there is an identifiable transition point.