Emergency Department Disposition and Point-of-Care Ultrasound in Biliary Disease: Propensity-Weighted Cohort Study

Area of Science:

• Emergency Medicine
• Abdominal Imaging
• Point-of-Care Ultrasound (POCUS)

Background:

• Biliary tract disease frequently causes abdominal pain in emergency department (ED) patients, leading to significant hospital admissions and return visits.
• Comparing ED outcomes based on POCUS use is crucial for optimizing care pathways for these patients.
• This study investigates outcomes for patients with biliary tract disease admitted directly versus those readmitted within 72 hours after initial ED discharge.

Purpose of the Study:

• To compare emergency department (ED) outcomes for patients with biliary tract disease based on the use of point-of-care ultrasound (POCUS) during their initial visit.
• To analyze differences in ED length of stay (LOS), costs, hospital LOS, intensive care unit (ICU) admission, and in-hospital mortality.
• To evaluate the safety and efficacy of POCUS in managing patients with biliary tract disease, particularly those initially discharged and later readmitted.

Main Methods:

• Retrospective cohort study of 1,228 adult patients admitted for biliary tract disease between 2021-2023.
• Propensity score weighting and multivariable regression with inverse probability of treatment weighting adjustment were used to control for baseline differences.
• Outcomes analyzed included ED LOS, costs, hospital LOS, ICU admission, and in-hospital mortality for direct admissions versus those readmitted within 72 hours.

Main Results:

• Initial discharge followed by readmission was not associated with worse clinical outcomes (mortality, ICU admission) compared to direct admission.
• Patients readmitted after initial discharge who received POCUS during their index ED visit had significantly shorter ED LOS and lower ED costs.
• POCUS use during the initial ED visit did not increase adverse events for patients ultimately requiring readmission.

Conclusions:

• Initial ED discharge appears safe for many low-risk patients with biliary tract disease who are subsequently readmitted within 72 hours.
• Incorporating POCUS into the initial ED evaluation can shorten ED LOS and reduce costs for patients who later require admission.
• POCUS use in the initial ED assessment of biliary tract disease shows no apparent negative effects on mortality or hospital/ICU LOS.