Lindelius Anna, Pettersson Hans, Adami Johanna, Törngren Staffan, Sondén Anders
Crit Ultrasound J. 2010 Dec;2(3):97-105. doi: 10.1007/s13089-010-0040-5. Epub 2010 Nov 12.
To evaluate the effect of surgeon-performed ultrasound on acute abdomen in specific patient subgroups regarding the diagnostic accuracy and further management. METHODS: Eight hundred patients attending the emergency department at Stockholm South General Hospital, Sweden, for abdominal pain, were randomized to either receive or not receive surgeon-performed ultrasound as a complement to routine management. Patients were divided into subgroups based on patient characteristics, symptoms or first preliminary diagnosis set at the emergency department before randomization. Outcomes measured were diagnostic accuracy, admission rate and requests for further examinations. Timing of surgery was evaluated for patients with peritonitis. RESULTS: Increased diagnostic accuracy was seen in patients with body mass index > 25, elevated C-reactive protein, peritonitis, age 30-59 years and/or upper abdominal pain. Decreased need for further examinations and/or fewer admissions were seen in all groups except in patients with a preliminary diagnosis of appendicitis. Among patients with non-specific abdominal pain, admission frequency was decreased with 14% when ultrasound was used (P = 0.007). Among patients with peritonitis, requiring surgery, 61% in the ultrasound group were admitted for surgery directly from the emergency department compared to 19% in the control group. CONCLUSION: In different ways, surgeon-performed ultrasound is helpful for the majority of patients admitted to the emergency department for abdominal pain. Taking into account other shown benefits and the lack of adverse effects, we find the method worth consideration for routine implementation.
评估外科医生实施的超声检查对特定患者亚组急性腹痛的诊断准确性及后续治疗的影响。方法：瑞典斯德哥尔摩南部综合医院急诊科的800例因腹痛就诊的患者被随机分为两组，一组接受外科医生实施的超声检查作为常规治疗的补充，另一组不接受。根据患者特征、症状或随机分组前在急诊科做出的初步诊断将患者分为亚组。测量的结果包括诊断准确性、入院率和进一步检查的需求。对腹膜炎患者的手术时机进行了评估。结果：体重指数>25、C反应蛋白升高、患有腹膜炎、年龄在30 - 59岁和/或上腹部疼痛的患者诊断准确性有所提高。除初步诊断为阑尾炎的患者外，所有组进一步检查的需求减少和/或入院人数减少。在非特异性腹痛患者中，使用超声检查时入院频率降低了14%（P = 0.007）。在需要手术的腹膜炎患者中，超声检查组61%的患者直接从急诊科入院接受手术，而对照组为19%。结论：外科医生实施的超声检查以不同方式对大多数因腹痛入住急诊科的患者有帮助。考虑到其他已显示的益处及无不良反应，我们认为该方法值得考虑常规实施。
