Estudio sobre la utilidad de la ecografía “point of care” en manos de cirujanos de urgencias

  1. I. Martínez-Casas 1
  2. A. Landaluce-Olavarría 2
  3. B. Ugarte-Sierra 2
  4. L. Ponchietti 3
  5. T. Nimmesgern 3
  6. F. M. Jiménez-Armenteros 1
  7. J. M. Capitán-Vallvey 1
  1. 1 Complejo Hospitalario de Jaén. Jaén.
  2. 2 Hospital Universitario de Galdakao. Galdakao, Vizcaya
  3. 3 Hospital Universitario de Torrevieja. Torrevieja, Alicante.
Show affiliations +
Journal:
Cirugía Andaluza

ISSN: 2695-3811,  1130-3212

Year of publication: 2019

Volume: 30

Issue: 1

Pages: 83-86

Type: Article

DOI: 10.37351/2019301.13 DIALNET GOOGLE SCHOLAR lock_openDialnet editor

More publications in: Cirugía Andaluza

Sustainable development goals

Abstract

Introduction: recently, Point of Care Ultrasound (POCUS) has extended its applications. The aim of the study was to analyse the value of POCUS in the hands of surgeons for daily practice decision making. Methods: prospective observational study, five surgeons in two hospitals performed POCUS to diagnose patients with acute abdomen or soft tissue infection. POCUS results were collected in a prospective database and compared with posterior conventional radiologist-performed results (either US or CT) and/or diagnosis at surgery. χ2 and Student t test were used for statistical analysis. Sensitivity, specificity, positive and negative predictive values were calculated to compare with standard. Results: during 16 months, 228 POCUS were performed in the study period to patients aged 44,5±22 years old. POCUS were divided in categories according to suspected diagnosis: RLQ pain (104), LLQ pain (13), RUQ pain (49), hernia (19), bowel obstruction (7), soft tissue infections (26) and postoperative abdominal complication (10). 75% of patients have posterior conventional radiologist test. Surgery was finally performed in 120 patients (30% without radiologist confirmation). Overall success rate for POCUS was 87%, without significative differences between centers. POCUS success rate was different when considering suspected diagnosis separately (p=0.018). Matches’ percentage between POCUS and radiologist diagnosis was 82%. POCUS success rate in patients operated straight after test was 85%. Finally, POCUS showed 90% sensitivity, 91% specificity, 95% PPV and 84% NPV. for surgical disease diagnosis. Conclusions: POCUS in the hands of ACS offers similar results than conventional radiologist-performed tests for surgical disease diagnosis and it’s useful in the decision making process.

Bibliographic References

  • YMollenkopf M, Tait N. Is it time to include point-of-care ultrasound in general surgery training? A review to stimulate discussion. ANZ J Surg. 2013; 14(83):908–11.
  • Beggs ED, Thomas PRS. Point of use ultrasound by general surgeons: review of the literature and suggestions for future practice. Int J Surg. 2013; 11: 12-17.
  • Cheung KH, Ong YS, Graham CA, Rainer TH, Cheung NK. Use of point-of-care ultrasound (POCUS) by emergency physicians for general surgical patients in resuscitation room. Crit Ultrasound J 2014; 6(Suppl 1): A20.
  • Morris A. Point of care ultrasound: seeing the future. Current problems Diagnostic Radiology 2015; 44: 3-7.
  • Moya AA, Sawyers KA, Chavarria PA, Sawyers KR. El futuro es ahora: Point of care Ultrasound. Revista Ciencias de la Salud UNIBE 2016; 1(1): 1-16.
  • Todsen T, Grønnebæk Tolsgaard M, Olsen BH, Henriksen BM, Hillingsø JG, Konge L, Jensen ML, Ringsted C. Reliable and Valid Assessment of Point-of-care Ultrasonography, Ann Surg 2015, 261(2), 309–315.
  • Solomon SD, Saldana F. Point-of-care ultrasound in medical education--stop listening and look. New Eng J Med 2014; 20(370): 1083-1085.
  • Zago, M., Martinez-Casas, I., Pereira, J., Mariani, D., Silva, A. R., Casamassima, A., et al. Tailored ultrasound learning for acute care surgeons: a review of the MUSEC (Modular UltraSound ESTES Course) project. Eur J Trauma Emerg Surg 2016; 42: 161-168.
  • Lindelius A, Torngren S, Pettersson H, Adami J. Role of surgeon-performed ultrasound on further management of patients with acute abdominal pain: a randomised controlled clinical trial. Emerg Med J. 2009; 26(8): 561–6.
  • Carroll PJ, Gibson D, El-Faedy O, Dunne C, Coffey C, Hannigan A, et al. Surgeon-performed ultrasound at the bedside for the detection of appendicitis and gallstones: systematic review and meta-analysis. Am J Surg. 2013; 205(1): 102–8.
Data source: Dialnet