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Diagnostic Accuracy of Point-of-Care Ultrasound in Detecting Nasogastric Tube Placement in Emergency Patients
Kemal Yilmaz1, Elif Günay İsmailoğlu2, Funda Karbek Akarca3
1Department of Internal Medicine, Ege University Hospital, İzmir, Turkey.
Background:
Point-of-care ultrasound (POCUS) is used to verify the position of the nasogastric tube as an alternative to conventional methods.
Aim:
This study aims to determine the diagnostic accuracy of POCUS in detecting nasogastric tube placement in emergency patients.
Methods:
This was a prospective diagnostic accuracy study conducted at an emergency department between August and November 2021. We included 72 consecutively recruited patients aged 18 years and older who were planned for nasogastric tube insertion. The index and reference tests were ultrasound and chest X-ray, respectively. Nasogastric tube placement was detected by ultrasound and X-ray methods in all patients. Sensitivity, specificity and predictive values were calculated.
Results:
Seventy-two patients (mean age: 69.49 ± 13.75, 55.6% male) were included. According to neck and gastric ultrasound, 58 nasogastric tubes (80.6%) could be detected. When POCUS was compared to X-rays, 56 (84.9%) were true positive and two (33.3%) were false positive. Fourteen nasogastric tubes (19.4%) could not be detected. When POCUS was compared to X-rays, four (66.7%) were true negative and 10 (15.1%) were false negative. A combination of neck and gastric ultrasound had a sensitivity of 84.84% (95% CI, 73.9%-92.49%), a specificity of 66.6% (95% CI, 22.28%-95.67%), a positive predictive value of 96.55% (95% CI, 89.99%-98.87%) and a negative predictive value of 28.57% (95% CI, 15.19%-47.19%). The percentage agreement was high (0.83%), and Gwet's AC1 statistic rated as moderate (AC1 = 0.46).
Conclusion:
POCUS can be used as a diagnostic tool in detecting nasogastric tube placement in the stomach but should be confirmed with a chest X-ray in patients with a negative ultrasound result.
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