Riassunto analitico
Background: Bowel Obstruction (BO) represents a critical condition that requires prompt diagnosis and appropriate management. Currently, the diagnosis of BO relies on clinical examination and imaging tests, including plain abdominal radiography (X-ray) and contrast-enhanced computed tomography (CT). In contrast, point-of-care ultrasound (POCUS) offers several advantages, such as rapid, repeatable, cost-effective, and radiation-free assessment. This study aims to compare the time efficiency of utilising POCUS versus a conventional diagnostic approach in the evaluation of BO.
Methods: This was a retrospective observational single-centre study that included all adult patients older than 18 years with a diagnosis of BO assessed at our emergency department (ED) between November 1, 2021, and December 31, 2023. Patients were categorised into two cohorts: the POCUS group, who underwent point-of-care ultrasound evaluation of the intestinal loops, and the non-POCUS group, who did not receive POCUS. In the POCUS group, an initial diagnosis of bowel obstruction was considered if at least three of the following ultrasound signs were present: dilatation of the bowel loops (>2.5 cm), thickening of valvulae conniventes (typical in jejunum and ileum), alternating peristalsis (to-and-fro sign), or free fluid among loops (tanga sign). For each group, only the final diagnosis was considered, which was determined after the contrast-enhanced CT scan was performed. The primary outcome was the time to diagnosis of BO (from the start of the emergency physician's assessment until the CT scan was completed). Secondary outcomes included overall median processing time (from the start of the emergency physician's assessment to the final patient disposition - surgery or admission), ED length of stay (LOS)(from patient arrival in the triage area until final disposition), the rate of abdominal radiography utilisation, hospital LOS (during hospital stay), and mortality.
Results: The study enrolled a total of 325 patients, of which 219 were excluded as they did not meet the inclusion criteria. The study cohort comprised 47 patients in the POCUS group and 59 patients in the non-POCUS group. The median time to diagnosis of BO was significantly shorter in the POCUS group at 121 minutes (±47.7), compared to 217 minutes (±111) in the non-POCUS group (p<0.001). Similarly, the overall median processing time was lower in the POCUS group at 276 minutes (±156) versus 376 minutes (±212) in the non-POCUS group (p=0.006). Furthermore, the median total ED LOS was reduced in the POCUS group (333 minutes ±177) compared to the non-POCUS group (436 minutes ±225) (p=0.010). In addition, the rate of abdominal radiography utilisation was less frequent in the POCUS group (49%) than in the non-POCUS group (78%) (p=0.004). Lastly, the median hospital LOS was almost the same between the two groups (p=1.000). Similarly, there was no significant difference in mortality rates between the two groups (p=0.063), as none of the patients in the POCUS group died, while five patients in the non-POCUS group passed away.
Conclusions: The findings indicate the practical utility of POCUS in facilitating the diagnosis of BO and influencing subsequent management decisions. While POCUS demonstrated reduced time to diagnosis and ED LOS compared to conventional methods, it did not appear to significantly impact hospital LOS or mortality rates. This may be due to individual variations in presentation timing in the ED, as well as the inherent progression of the condition. Further exploration is necessary to assess the long-term outcomes and cost-effectiveness of integrating POCUS into routine ED practice for BO diagnosis and management.
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