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

Dupriez, Florence Niset, Alexandre Couvreur, Claire Marissiaux, Laurent Gendebien, Félix Peyskens, Laurent Germeau, Boris Fasseaux, Antoine Rodrigues de Castro, Bastian Penaloza, Andrea Vanpee, Dominique [UCL] Bobbia, Xavier et al.[show all]

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 (χ 2 = 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.