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Point-of-care biliary ultrasound in the emergency department (BUSED): implications for surgical referral and emergency department wait times
  1. Richard Hilsden1,
  2. Rob Leeper1,2,
  3. Jennifer Koichopolos1,
  4. Jeremy Derek Vandelinde3,
  5. Neil Parry1,2,
  6. Drew Thompson4,
  7. Frank Myslik4
  1. 1 Department of Surgery, Western University, London, Ontario, Canada
  2. 2 Division of Critical Care Medicine, Western University, London, Ontario, Canada
  3. 3 Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
  4. 4 Division of Emergency Medicine, Western University, London, Ontario, Canada
  1. Correspondence to Dr Richard Hilsden, Department of Surgery, Western University, London, ON N6A 5A5, Canada; richard.hilsden{at}londonhospitals.ca

Abstract

Background Patients with uncomplicated biliary disease frequently present to the emergency department for assessment. To improve bedside clinical decision making, biliary point-of-care ultrasound (POCUS) in the emergency department has emerged as a diagnostic tool. The purpose of this study is to analyze the usefulness of POCUS in predicting the need for surgical intervention in biliary disease.

Methods A retrospective study of patients visiting the emergency department who received a biliary POCUS from December 1, 2016 to July 15, 2017 was performed. The physician interpretations of the biliary POCUS scans were collected, as well as data from the electronic health records including lab values, the subsequent use of diagnostic imaging, surgical consultation or intervention, and 28 days follow-up for representation or complication.

Results Two hundred and eighty-three patients were identified as having received biliary POCUS. Of the patients referred to general surgery who received biliary POCUS 43% received a cholecystectomy. For the outcome of cholecystectomy, the finding of gallstones on POCUS was 55% sensitive (95% CI 40% to 70%) and 92% specific (95% CI 87% to 95%). A sonographic Murphy’s sign was 16% sensitive (95% CI 7% to 30%) but 95% specific (95% CI 92% to 97%) and, gallbladder wall thickness was 18% sensitive (95% CI 9% to 33%) and 98% specific (95% CI 95% to 99%). Patients who received POCUS but did not proceed to confirmatory radiology department imaging had a shorter length of stay (433 min ± 50 min vs. 309 min ± 30 min, P<0.001).

Discussion Point-of-care biliary ultrasound performed by emergency physicians provides timely access to diagnostic information. Positive findings of gallstones and increased gallbladder wall thickness are highly predictive of the need for surgical intervention, and use of POCUS is associated with shorter ER visits.

Level of evidence Retrospective cohort study, level III.

  • gallbladder
  • point of care
  • ultrasonography
  • cholecystectomy

This is an Open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

https://doi.org/10.1136/tsaco-2018-000164

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    Footnotes

    • Contributors RH, FM, RL, DT, and NP conceptualized, designed, supervised, and allocated resources for this research. JDV, JK, and FM completed the data collection. RH and JDV performed the statistical analysis. All authors contributed to the analysis of the results. All authors contributed to the writing of the final article text.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Patient consent Not required.

    • Ethics approval University of Western Ontario research ethics board.

    • Provenance and peer review Not commissioned; externally peer reviewed.