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MA: Ultrasound accurately diagnoses small bowel obstruction
Clinical Question
Is ultrasound accurate in diagnosing small bowel obstruction?
Bottom line
The lack of a unified gold standard notwithstanding, it appears that diagnostic ultrasound is reasonably accurate in diagnosing small bowel obstruction in symptomatic patients. 2a-
Reference
Study design: Meta-analysis (other)
Funding: Unfunded
Setting: Emergency department
Synopsis
These authors searched multiple databases and trial registries to find prospective studies of ultrasound for the diagnosis of small bowel obstructions in symptomatic patients regardless of age. They also searched the reference lists of retrieved papers and consulted with experts in the field to minimize missing relevant studies. The included studies needed to have a gold standard against which the ultrasound was compared (though the authors did not specify which gold standard was necessary). Two researchers independently assessed the inclusion and methodologic quality of the studies, with disagreements settled by a third member of the team. Ultimately they included 11 studies with 1178 patients. The gold standards used included computed tomography, enteroclysis, surgical diagnosis, discharge diagnosis, and clinical follow-up. Five of the studies were conducted in emergency departments. The patients ranged from 3 days to 98 years of age (mean = 50 years of age) and 75% were men. Overall, the studies were of low or moderate risk of bias. Based on whatever gold standard was used in the study, the overall accuracy of ultrasound was quite high: 92% sensitive (95% CI 89% - 95%) and 97% specific (88% - 99%). This translates to a positive likelihood ratio of 27.5 (7.7 - 98.4) and a negative likelihood ratio of 0.08 (0.06 - 0.11). The authors found some statistical heterogeneity, but found no graphical evidence for publication bias.
Reviewer
Henry C. Barry, MD, MS
Professor
Michigan State University
East Lansing, MI
Comments
Nice to know but I wonder if the reviewer was actually an ED doc. There is no description of who actually did the ultrasounds. Was it the diagnostic imaging dept or POCUS done by ED docs. An ED doc reviewer would have included this important tidbit. This leaves me in the position of having the look the article up myself. (I guess not a bad thing!) I would suggest however that future similar reviews be more specific about the context.
As a practising general radiologist for 35 years in a tertiary hospital I have no experience whatsoever at this point with using US in diagnosing SBO , and would not be looking forward to it’s sfter hours use when most SBOs get diagnosed.
Prefer CT
less investigation!
What is the impact on preop decision / assessment for surgical treatment in SBO : replace CT ? as this will for sure reduce the radiation hazard.
Between ultrasound, CT, and x-rays, it already seems like ultrasound can be the hardest to get, due to limited availability of technicians after-hours, and the time involved to get the scan done. Also, I think the CT would often still be requested for surgical planning purposes.
good poem