Emergency Department (ED), Cliniques Universitaires Saint-Luc (CUSL), Brussels.
Intensive Care Unit, Hôpital de Jolimont, rue Ferrer 159, La Louvière.
Eur J Emerg Med. 2021 Oct 1;28(5):344-351. doi: 10.1097/MEJ.0000000000000815.
Cholecystitis secondary to gallstone migration is the most common suspected diagnosis for right upper quadrant pain in emergency departments, with radiology-performed ultrasound (RADUS) being the main diagnostic tool. The primary aim of this review was to assess the ability of emergency physicians to perform emergency ultrasound (EUS) compared to RADUS to diagnose cholelithiasis and cholecystitis. A systematic search was performed using Embase, Central (Cochrane library), Web of Science, MEDLINE, Google Scholar, prospective trial registries, and OpenSIGLE databases as well as hand-search of articles. Two physicians independently selected the articles. Assessment of methodological quality was performed using the Quality Assessment of Diagnostic Accuracy Studies 2 tool. Clinical and methodological heterogeneity were qualitatively reported and discussed. Seven prospective studies were selected involving a total of 1061 subjects undergoing EUS. The included studies all used RADUS as the reference standard and emergency physician-performed EUS as the index test. Included studies mostly reported diagnostic accuracy for cholelithiasis diagnosis whereas only one study mentioned diagnostic accuracy for cholecystitis. Clinical and methodological heterogeneity between included studies prevented a meta-analysis. This review shows there is good agreement between EUS and RADUS to assess the gallbladder for cholelithiasis and therefore supports its use by emergency physicians for that matter. Nevertheless, this work identified clinical and methodological heterogeneity along with a poor description EUS operators' experience. In the future, larger studies should include a larger population of EUS operators, specify their background, and compare EUS to the final diagnosis to evaluate performances for gallbladder diagnostic accuracy.
胆石迁移继发的胆囊炎是急诊科右上腹疼痛最常见的疑似诊断，放射科进行的超声检查（RADUS）是主要的诊断工具。本综述的主要目的是评估急诊医师进行急诊超声（EUS）与 RADUS 诊断胆石症和胆囊炎的能力。使用 Embase、CENTRAL（Cochrane 图书馆）、Web of Science、MEDLINE、Google Scholar、前瞻性试验登记处和 OpenSIGLE 数据库以及文章的手工检索进行了系统搜索。两名医生独立选择文章。使用诊断准确性研究质量评估工具 2 评估方法学质量。定性报告和讨论了临床和方法学异质性。选择了 7 项涉及总共 1061 名接受 EUS 检查的受试者的前瞻性研究。纳入的研究均使用 RADUS 作为参考标准和急诊医师进行的 EUS 作为指标试验。纳入的研究主要报告了胆石症诊断的诊断准确性，而只有一项研究提到了胆囊炎的诊断准确性。纳入研究之间的临床和方法学异质性妨碍了荟萃分析。本综述表明，EUS 和 RADUS 用于评估胆囊的胆石症具有很好的一致性，因此支持急诊医师对此类疾病的使用。然而，这项工作发现了临床和方法学的异质性，以及对 EUS 操作者经验的描述不佳。未来，更大规模的研究应包括更多的 EUS 操作者，具体说明他们的背景，并将 EUS 与最终诊断进行比较，以评估对胆囊诊断准确性的性能。
