Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States.
Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States.
Am J Emerg Med. 2018 Feb;36(2):234-242. doi: 10.1016/j.ajem.2017.07.085. Epub 2017 Jul 29.
Small bowel obstruction (SBO) is a common presentation to the Emergency Department (ED). While computed tomography (CT) is frequently utilized to confirm the diagnosis, this modality is expensive, exposes patients to radiation, may lead to time delays, and is not universally available. This study aimed to determine the test characteristics of ultrasound for the diagnosis of SBO.
PubMed, CINAHL, Scopus, the Cochrane Database of Systematic Reviews, and the Cochrane Central Register of Controlled Trials were assessed for prospective trials evaluating the accuracy of ultrasound for the detection of SBO. Data were double extracted into a predefined worksheet and quality analysis was performed using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool.
This systematic review identified 11 studies comprising 1178 total patients. Overall, ultrasound was found to be 92.4% sensitive (95% CI 89.0% to 94.7%) and 96.6% specific (95% CI 88.4% to 99.1%) with a positive likelihood ratio of 27.5 (95% CI 7.7 to 98.4) and a negative likelihood ratio of 0.08 (95% CI 0.06 to 0.11).
The existing literature suggests that ultrasound is a valuable tool in the diagnosis of SBO with a sensitivity and specificity comparable to that of CT. Ultrasound may save time and radiation exposure, while also allowing for serial examinations of patients to assess for resolution of the SBO. It may be particularly valuable in settings with limited or no access to CT. Future studies should include more studies in the Emergency Department setting, comparison of probe choices, and inclusion of more pediatric patients.
小肠梗阻（SBO）是急诊科常见的表现。虽然计算机断层扫描（CT）常用于确认诊断，但这种方法昂贵，使患者暴露于辐射下，可能导致时间延迟，并且并非普遍可用。本研究旨在确定超声诊断 SBO 的测试特征。
评估了 PubMed、CINAHL、Scopus、Cochrane 系统评价数据库和 Cochrane 对照试验中心注册库，以寻找评估超声检测 SBO 准确性的前瞻性试验。将数据双份提取到预定义的工作表中，并使用诊断准确性研究的质量评估（QUADAS-2）工具进行质量分析。
本系统评价共纳入 11 项研究，共计 1178 例患者。总体而言，超声的敏感性为 92.4%（95%CI 89.0%至 94.7%），特异性为 96.6%（95%CI 88.4%至 99.1%），阳性似然比为 27.5（95%CI 7.7 至 98.4），阴性似然比为 0.08（95%CI 0.06 至 0.11）。
现有文献表明，超声是诊断 SBO 的一种有价值的工具，其敏感性和特异性可与 CT 相媲美。超声可节省时间和辐射暴露，同时还可以对患者进行连续检查，以评估 SBO 是否缓解。在 CT 有限或无法获得的情况下，它可能特别有价值。未来的研究应包括更多在急诊科环境中的研究、探头选择的比较以及更多儿科患者的纳入。
