Role of emergency physician–performed ultrasound in the differential diagnosis of abdominal pain

Objectives: This prospective study was performed to evaluate the diagnostic accuracy of bedside point-of-care abdominal ultrasonography performed by emergency physician in patients with non-traumatic acute abdominal pain. Methods: The patients, who were admitted to emergency department due to abdominal pain, were included in this study. The emergency physician obtained a routine history, physical examination, blood draws, and ordered diagnostic imaging. After the initial clinical examinations, all the patients underwent ultrasonography for abdominal pathologies by emergency physician and radiologist, respectively. Point-of-care abdominal ultrasonography compared with abdominal ultrasonography performed by radiologist as the gold standard. Results: The study included 122 patients. Gallbladder and appendix pathologies were the most commonly detected in the abdominal ultrasonography. Compared with abdominal ultrasonography, point-of-care abdominal ultrasonography was found to have 89% sensitivity and 94% specificity in gallbladder pathologies; 91% sensitivity and 91% specificity in acute appendicitis; 79% sensitivity and 97% specificity in abdominal free fluid; 83% sensitivity and 96% specificity in ovarian pathologies. Compared to final diagnosis, preliminary diagnoses of emergency physicians were correct in 92 (75.4%) patients. Conclusion: This study showed that emergency physicians were successful in identifying abdominal organ pathologies with point-of-care abdominal ultrasonography after training.

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Approach to the Patient with Abdominal Pain

10.2310/em.4052 ◽

2020 ◽

Author(s):

Dana Sajed

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Chronic Conditions ◽

Acute Abdominal Pain ◽

Point Of Care ◽

Abdominal Ultrasonography ◽

Pediatric Populations ◽

Ed Visits ◽

Point Of Care Ultrasonography

Abdominal pain is the most common presenting complaint in the emergency department (ED), accounting for nearly 8% of ED visits. Although many chronic conditions may cause pain in the abdomen, acute abdominal pain, defined as undiagnosed pain present for less than 1 week, is of greatest concern to the emergency practitioner. For many reasons, acute abdominal pain is often diagnostically challenging. Abdominal pain may be due to numerous causes, including gastrointestinal, genitourinary, cardiovascular, pulmonary, and other sources. Symptoms may fluctuate or change in nature, and the quality of pain can be difficult for the patient to describe. Physical examination findings, although important, are variable and can even be misleading. Despite being such a common presenting complaint, misdiagnosis is not uncommon and results in a high percentage of medicolegal actions in both and adult and pediatric populations. This review contains 5 figures, 8 tables, and 92 references Key words: abdominal computed tomography, abdominal pain, abdominal ultrasonography, pain management, point-of-care ultrasonography

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Approach to the Patient with Abdominal Pain

10.2310/fm.4052 ◽

2016 ◽

Author(s):

Dana Sajed

Keyword(s):

Computed Tomography ◽

Abdominal Pain ◽

Chronic Conditions ◽

Acute Abdominal Pain ◽

Point Of Care ◽

Abdominal Ultrasonography ◽

Pediatric Populations ◽

Ed Visits ◽

Point Of Care Ultrasonography

Abdominal pain is the most common presenting complaint in the emergency department (ED), accounting for nearly 8% of ED visits. Although many chronic conditions may cause pain in the abdomen, acute abdominal pain, defined as undiagnosed pain present for less than 1 week, is of greatest concern to the emergency practitioner. For many reasons, acute abdominal pain is often diagnostically challenging. Abdominal pain may be due to numerous causes, including gastrointestinal, genitourinary, cardiovascular, pulmonary, and other sources. Symptoms may fluctuate or change in nature, and the quality of pain can be difficult for the patient to describe. Physical examination findings, although important, are variable and can even be misleading. Despite being such a common presenting complaint, misdiagnosis is not uncommon and results in a high percentage of medicolegal actions in both and adult and pediatric populations. Key words: abdominal computed tomography, abdominal pain, abdominal ultrasonography, pain management, point-of-care ultrasonography

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Bayesian Diagnostic Probabilities without Assuming Independence of Symptoms

Methods of Information in Medicine ◽

10.1055/s-0038-1634813 ◽

1991 ◽

Vol 30 (01) ◽

pp. 15-22 ◽

Cited By ~ 23

Author(s):

A. Gammerman ◽

A. R. Thatcher

Keyword(s):

Abdominal Pain ◽

Acute Abdominal Pain ◽

Final Diagnosis ◽

Bayes Theorem ◽

Bayes Method ◽

Hospital Records ◽

Computer Diagnosis ◽

Bayes Model ◽

Chi Squared ◽

Past Data

The paper describes an application of Bayes’ Theorem to the problem of estimating from past data the probabilities that patients have certain diseases, given their symptoms. The data consist of hospital records of patients who suffered acute abdominal pain. For each patient the records showed a large number of symptoms and the final diagnosis, to one of nine diseases or diagnostic groups. Most current methods of computer diagnosis use the “Simple Bayes” model in which the symptoms are assumed to be independent, but the present paper does not make this assumption. Those symptoms (or lack of symptoms) which are most relevant to the diagnosis of each disease are identified by a sequence of chi-squared tests. The computer diagnoses obtained as a result of the implementation of this approach are compared with those given by the “Simple Bayes” method, by the method of classification trees (CART), and also with the preliminary and final diagnoses made by physicians.

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ROLE OF ULTRASOUND IN DIAGNOSIS AND EVALUATION OF ACUTE ABDOMINAL PAIN IN PREGNANCY

ALEXMED ePosters ◽

10.21608/alexpo.2020.49098.1067 ◽

2020 ◽

Vol 0 (0) ◽

pp. 0-0

Author(s):

Khaled Montasser

Keyword(s):

Abdominal Pain ◽

Acute Abdominal Pain ◽

In Pregnancy

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Point-of-Care Ultrasound in the Diagnosis of Acute Abdominal Pain

Operative Techniques and Recent Advances in Acute Care and Emergency Surgery ◽

10.1007/978-3-319-95114-0_27 ◽

2019 ◽

pp. 383-401

Author(s):

Francesca Cortellaro ◽

Cristiano Perani ◽

Linda Guarnieri ◽

Laura Ferrari ◽

Michela Cazzaniga ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Abdominal Pain ◽

Point Of Care ◽

Point Of Care Ultrasound

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Abdominal pain: a survey of clinically important outcomes for future research

CJEM ◽

10.1017/s1481803500012707 ◽

2010 ◽

Vol 12 (06) ◽

pp. 485-490 ◽

Cited By ~ 4

Author(s):

Angela M. Mills ◽

Anthony J. Dean ◽

Judd E. Hollander ◽

Esther H. Chen

Keyword(s):

Abdominal Pain ◽

Acute Abdominal Pain ◽

Future Research ◽

Original Research ◽

Emergency Physicians ◽

Cross Sectional Survey ◽

Cross Sectional ◽

Convenience Sample ◽

Clinically Significant

ABSTRACT Objective: We aimed to use the consensus opinion of a group of expert emergency physicians to derive a set of emergency diagnoses for acute abdominal pain that might be used as clinically significant outcomes for future research. Methods: We conducted a cross-sectional survey of a convenience sample of emergency physicians with expertise in abdominal pain. These experts were authors of textbook chapters, peer-reviewed original research with a focus on abdominal pain or widely published clinical guidelines. Respondents were asked to categorize 50 possible diagnoses of acute abdominal pain into 1 of 3 categories: 1) unacceptable not to diagnose on the first emergency department (ED) visit; 2) although optimal to diagnose on first visit, failure to diagnose would not be expected to have serious adverse consequences provided the patient had follow-up within the next 2–7 days; 3) if not diagnosed during the first visit, unlikely to cause long-term risk to the patient provided the patient had follow-up within the next 1–2 months. Standard descriptive statistical analysis was used to summarize survey data. Results: Thirty emergency physicians completed the survey. Of 50 total diagnoses, 16 were categorized as “unacceptable not to diagnose in the ED” with greater than 85% agreement, and 12 were categorized as “acceptable not to diagnose in the ED” with greater than 85% agreement. Conclusion: Our study identifies a set of abdominal pain conditions considered by expert emergency physicians to be clinically important to diagnose during the initial ED visit. These diseases may be used as “clinically significant” outcomes for future research on abdominal pain.

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