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[Abdominal Sonography in Medical Emergencies: do Complete Abdominal Scans offer Advantages over a Focused Strategy?]
Günter Maximilian Schiele1, Monika Pobiruchin2, Uwe Weickert1
1Medizinische Klinik II, Klinikum Am Gesundbrunnen Heilbronn, SLK-Klinken Heilbronn GmbH.
Purpose:
To determine, whether in case of abdominal emergencies, complete abdominal ultrasound scans offer advantages over a goal-directed strategy in regard to problem-solving and detection of relevant pathologies.
Material And Methods:
Retrospective analysis of consecutive emergency exams that were ordered by the ER in our gastroenterological sonography unit from 06/2012 to 06/2013. All patients got an ultrasound of the complete abdomen.We compared the findings of the complete abdomen study with the findings of a hypothetical focused sonography. The scope of the focused sonography depended on the presenting problem. An ultrasound finding was classified as relevant, if it triggered diagnostic or therapeutic consequences.Sensitivity and negative predictive value of the goal-directed strategy were calculated with the full abdominal scan as reference.
Results:
629 patients (53 % female), with an average age of 59 years (18-97) had emergency sonographies.Focused sonography detected relevant pathologies in 63 % (396/629) of patients. In 17 % of patients (106/629) complete abdominal ultrasound led to additional relevant findings. This translates into a number needed to scan for relevant pathologies of 6. Focused sonography had a sensitivity of 76 % and a negative predictive value of 64 % for relevant pathologies.The problem could be solved by 57 % of focused sonographies, whereas complete abdominal scans solved the problem in 63 % for a number needed to scan of 18. Sensitivity and negative predictive value of focused sonography were 87 % and 63 % respectively.The rate of problem-solving-scans depended on the indication (with jaundice having the highest (90 %) and left-upper-quadrant pain having the lowest (45 %) rate) and increased with age (37 % for the second decade up to 85 % for the 10th decade).
Conclusion:
In medical abdominal emergencies, ultrasound scans of the complete abdomen detect more relevant pathologies and solve more problems than focused sonography does.
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