Ultrasonography by emergency physicians in patients with suspected cholecystitis

This article investigates the use of bedside abdominal ultrasonography (BAU ) performed by emergency physicians (EPs) to screen patients for cholelithi asis and cholecystitis. In this prospective study EPs performed BAU on 116 patients. Agreement between BAU and formal abdominal ultrasound (FUS) perfo rmed in the radiology department for detecting cholelithiasis and cholecyst itis was determined using Kappa statistics, Test characteristics of BAU for detecting cholelithiasis and acute cholecystitis were calculated. Agreemen t between BAU and FUS was 0.71 for cholelithiasis and 0.46 for acute cholec ystitis. Test characteristics of BAU for cholelithiasis were sensitivity 92 %, specificity 78%, positive predictive value (PPV) 86%, negative predictiv e value (NPV) 88%. Test characteristics of BAU for acute cholecystitis comp ared with clinical follow-up were sensitivity 91%, specificity 66%, PPV 70% , NPV 90%, BAU may be used to exclude cholelithiasis and is sensitive for c holecystitis. However, when EPs with limited experience identify cholecysti tis a confirmatory test is warranted before cholecystectomy, (Am J Emerg Me d 2001;19:32-36. Copyright (C) 2001 by W.B. Saunders Company).