Surgeon-Performed Pocket Ultrasound for the Diagnosis of Acute Cholecystitis in the Emergency Setting: A Pilot Study

Introduction: Ultrasonography is the first-line imaging study for the assessment of biliary disease. Palm (pocket) Ultrasound (PUS), particularly in the hands of the treating surgeon, may represent an evolution in surgical decision-making and may expedite care and reduce cost.

Purpose: The purpose of this study was to evaluate the initial experience of bedside PUS for the diagnosis of acute cholecystitis (AC) by surgical residents.

Methods: During the study period, adult patients suspected clinically by the surgeon on call as suffering from cholecystitis were prospectively enrolled to the study and underwent first a bedside pocket ultrasound study of the gall bladder the surgeon, followed by formal study by resident on call in radiology. Senior sonographers trained the surgeons in hands-on sessions. The sonographic images were saved for reevaluation by senior sonographers. The radiologist diagnosis was used as the correct diagnosis.

Results: A total of 93 patients with abdominal pain, suspicious for cholecystitis, were examined with PUS in the ER by surgical residents followed by the radiological residents in the US suit. Ten surgical residents participated in the study, with an average of 9 studies per resident. Cholecystitis was diagnosed in 23 patients (25%) by the radiologists. The performance of the surgeons was excellent for identifying the gall bladder, good for identifying stones, but quite poor for diagnosing cholecystitis(sensitivity =78.3%, specificity=61.4% and accuracy of 65.6%).

Conclusions: This pilot study shows that surgeon-Performed Palm Ultrasound following short training, is highly reliable in diagnosing gallstones, while diagnosing AC is still more challenging. With more experience and training, the diagnostic accuracy is expected to be sufficient in order to omit the radiology dept. services and save time in the ER.