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Evaluation of point-of-care ultrasound use in the diagnostic approach for right upper quadrant abdominal pain management in the emergency department: a prospective study

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Abstract

Point-of-care ultrasound (PoCUS) is commonly used at the bedside in the emergency department (ED) as part of clinical examinations. Studies frequently investigate PoCUS diagnostic accuracy, although its contribution to the overall diagnostic approach is less often evaluated. The primary objective of this prospective, multicenter, cohort study was to assess the contribution of PoCUS to the overall diagnostic approach of patients with right upper quadrant abdominal pain. Two independent members of an adjudication committee, who were blind to the intervention, independently evaluated the diagnostic approaches before and after PoCUS for the same patient. The study included 62 patients admitted to the ED with non-traumatic right upper quadrant abdominal pain from September 1, 2022, to March 6, 2023. The contribution of PoCUS to the diagnostic approach was evaluated using a proportion test assuming that 75% of diagnostic approaches would be better or comparable with PoCUS. Wilcoxon signed-rank tests evaluated the impact of PoCUS on the mean number of differential diagnoses, planned treatments, and complementary diagnostic tests. Overall, 60 (97%) diagnostic approaches were comparable or better with PoCUS (χ2 = 15.9, p < 0.01). With PoCUS, the mean number of differential diagnoses significantly decreased by 2.3 (95% CI – 2.7 to – 1.5) (p < 0.01), proposed treatments by 1.3 (95% CI – 1.8 to – 0.9) (p < 0.01), and complementary diagnostic tests by 1.3 (95% CI – 1.7 to – 1.0) (p < 0.01). These findings show that PoCUS positively impacts the diagnostic approach and significantly decreases the mean number of differential diagnoses, treatments, and complementary tests.

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Acknowledgements

The authors would like to acknowledge Celine Bugli, Department of Statistics, Université Catholique de Louvain, Belgium. The authors would also like to acknowledge Anne-Charlotte Dekeister, research assistant, Cliniques Universitaires Saint-Luc, Belgium and Victoria Grace, English editing, France.

Funding

The authors did not receive support from any organization for the submitted work. No funding was received to assist with the preparation of this manuscript. No funding was received for conducting this study. No funds, grant, or other support was received.

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Authors and Affiliations

  1. Emergency Department, Cliniques Universitaires Saint-Luc, Avenue Hippocrate, 10, 1200, Brussels, Belgium

    Florence Dupriez, Alexandre Niset, Claire Couvreur, Bastian Rodrigues de Castro & Andrea Penaloza

  2. Emergency Department, Centre Hospitalier Universitaire de Liège, Liège, Belgium

    Laurent Marissiaux

  3. Emergency Department, Hôpital de Jolimont, Lobbes, Lobbes, Belgium

    Félix Gendebien

  4. Emergency Department, Grand Hôpital de Charleroi, Charleroi, Belgium

    Laurent Peyskens

  5. Emergency Department, Cliniques Saint-Pierre Ottignies, Ottignies, Belgium

    Boris Germeau

  6. Emergency Department, Hôpital de Jolimont, Lobbes, Haine Saint Paul, Belgium

    Antoine Fasseaux

  7. Institute of Health and Society and CHU UCL Namur, UCLOUVAIN, Ottignies-Louvain-la-Neuve, Belgium

    Dominique Vanpee

  8. Emergency Department, CHU Montpellier, Montpellier, France

    Xavier Bobbia

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  1. Florence Dupriez
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Contributions

All authors contributed to the study conception and design. Material preparation as well as data collection and analysis were performed by FD, AN, and CC. The first draft of the manuscript was written by FD and all authors commented on subsequent versions. All authors read and approved the final manuscript.

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Correspondence to Florence Dupriez.

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The authors declare they have no relevant financial or non-financial interest to disclose. The authors have no conflicts of interest to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

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Dupriez, F., Niset, A., Couvreur, C. et al. Evaluation of point-of-care ultrasound use in the diagnostic approach for right upper quadrant abdominal pain management in the emergency department: a prospective study. Intern Emerg Med 19, 803–811 (2024). https://doi.org/10.1007/s11739-023-03480-9

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