Complete abdominal scans or goal-directed scans for abdominal emergencies?

Purpose: To determine, whether in case of abdominal emergencies, goal-directed sonography is as effective as a complete abdominal scan or if important pathologies will be missed by a focused strategy.

Material and methods: Retrospective analysis of consecutive emergency exams that were ordered by the medical ER in our medical sonography unit in the course of one year. All patients got an ultrasound of the complete abdomen.

We compared the findings of the complete abdomen study with the findings of a hypothetical focused sonography. The scope of the focused sonography depended on the presenting problem. 17 groups of clinical problems were created, each with its own regions that a focused sonography would cover (e.g. right upper quadrant pain, acute kidney failure, jaundice).

Ultrasound findings were classified as relevant or irrelevant. A finding was considered relevant, if it triggered diagnostic or therapeutic consequences.

Results: 629 patients, 47% male and 53% female, average age 59 years (+/- 20, 18 – 97) had emergency sonografies.

Focused sonography detected relevant pathologies in 63% (396/629) of patients. In 17% of patients (106/629) complete abdominal ultrasound led to additional clinically meaningful findings. This translates into a number needed to scan (NNS) for relevant pathologies of only 6.

The issues relevant to the exam could be answered by 57% (361/629) of focused sonografies, whereas complete abdominal scans solved the problem in 63% (396/629) for a NNS of 17.

The rate of problem-solving-scans depended on the indication (with jaundice having the highest (90%) and left-upper-quadrant pain having the lowest (45%) rate) and increased with age (37% for the second decade up to 85% for the 10th decade).

Conclusion: Complete abdominal ultrasound scans are superior to focused sonography for (medical) abdominal emergencies. In one of 6 patients a relevant pathology will be missed, if a goal-directed strategy is followed.