Jackie Anderson, DO | PGY3
Study Question:
How accurate is ER POCUS in identifying SBO as compared to abdominal CT?
Methods/Study Design:
Prospective, multicenter, observational study
Occurred between July 2014 and May 2017
ER POCUS interpreted at bedside by ER physician (attending, fellow, PGY2, PGY3) in real-time; also interpreted retrospectively by an expert reviewer after CT results were available; all reviewers were blinded
POCUS performed with curvilinear probe
Patients were evaluated for SBO if attending was concerned based on presentation and symptoms; patients who did not receive abdominal CT were excluded
Criteria used to diagnose SBO on POCUS: small bowel dilation >= 25mm, abnormal peristalsis
Criteria used to support SBO diagnosis on POCUS: transition point, intraperitoneal fluid, bowel wall edema (no specific measurement cutoff was used)
Results:
217 patients with overall SBO prevalence of 42.9%
POCUS: sensitivity 88%, specificity 54%
Expert review: sensitivity 89%, specificity 82%
POCUS: 11 false negative, 57 false positives when compared to CT
Strengths/Limitations:
All reviewers were blinded
ER POCUS performers had no prior training in SBO evaluations
ER POCUS classified as “indeterminate” was determined to be positive for SBO; CT interpretations of “ileus vs. SBO” were determined to be positive for SBO
Different machines and performers were used among three hospitals with different patient populations
Authors’ Conclusion:
ER POCUS is moderately sensitive for SBO and less specific
Relevance to EM:
Opportunity for initial evaluation vs waiting for PO contrast and CT scan
Scanners with specific training performed better