ASSESSMENT OF THE USABILITY OF ULTRASONOGRAPHY BY EMERGENCY PHYSICIANS IN THE DIAGNOSIS OF ACUTE CHOLECYSTITIS

Abstract

Background: Early diagnosis of acute stony cholecystitis allows rapid treatment and reduces mortality and morbidity. In this paper, we aimed to assess the competence of emergency medicine physicians in the ultrasonographic diagnosis of gallbladder pathologies in patients presenting at emergency departments with upper right quadrant pain. Methods: One hundred and sixty-eight patients over the age of 18 years presenting at the Emergency Medicine clinic on January 1 to July 1, 2013, were included in this prospective study. Ultrasonography (USG) of the upper right quadrant was applied to all patients at emergency services and the radiology unit. The results were statistically analyzed with the radiology clinic reports accepted as the gold standard. Results: With the radiology reports considered to be the gold standard, emergency physicians were able to identify the sonographic Murphy sign with 98.2% accuracy (95% confidence interval [CI] of 96.2-100), positive gallstones at 89.9% (95% CI 85.3-94.4), pericholecystic fluid at 89.3% (95% CI 84.6-94.0), and finally acute stony cholecystitis diagnosis at 98.2% (95% CI 96.2-100). Conclusion: Emergency medicine physicians may perform gallbladder USG procedures with similar results to those performed by radiology physicians following standardized training. Thus, USG may assume a function similar to the stethoscope as part of physical examination aiming toward clinical decisions with respect to the assessment of gallbladder diseases, and the decision to discharge patients from the emergency service of hospitalization in the clinic.