5 research outputs found
Randomized clinical trial of bedside ultrasound among patients with abdominal pain in the emergency department: impact on patient satisfaction and health care consumption
Background\ud
\ud
Previous research shows that surgeon-performed ultrasound for patients presenting with abdominal pain in the emergency department leads both to higher diagnostic accuracy and to other benefits. We have evaluated the level of patient satisfaction, health condition and further health care consumption after discharge from the emergency department.\ud
Methods\ud
\ud
A total of 800 patients who attended the emergency department for abdominal pain were randomized to surgeon-performed ultrasound or not as a complement to standard examination. All patients were interviewed by telephone six weeks after the visit to the emergency department using a structured questionnaire including information about health condition, satisfaction and medical examinations. A regional health register was used to check health care consumption over two years and mortality was checked for in the personal data register.\ud
Results\ud
\ud
We found a higher self-rated patient satisfaction in the ultrasound group when leaving the emergency department. After six weeks the figures were equal. There were fewer patients in the ultrasound group with completed or planned complementary examinations after six weeks (31.1%) compared with the control group (41.4%), p = 0.004. There was no difference found in the two-year health care consumption or mortality between the groups.\ud
Conclusion\ud
\ud
For patients with acute abdominal pain, bedside ultrasound examination is related to higher satisfaction and decreased short-term health care consumption. No major effects were revealed when evaluating effects on a long-term basis, including mortality. The previously proven benefit together with the lack of adverse effects from the method makes ultrasound well worth considering for implementation in emergency departments
The role of surgeon-performed ultrasound in the management of the acute abdomen
The overall objective of this thesis was to evaluate the effects of
bedside surgeon-performed ultrasound on the diagnostic accuracy and
management of the patient admitted to the emergency department for
abdominal pain.
Methods
We randomized 800 patients who attended the emergency department at
Stockholm South General Hospital, Sweden, for abdominal pain, to either
receive or not receive surgeon-performed ultrasound as a complement to
routine management. The patients were followed up by a telephone
interview after six weeks and by a registry follow-up after two years.
Outcome measures included proportion of correct diagnoses, the number of
complementary investigations, admission rate, time for surgery if
required, time consumption at the emergency department and at hospital if
admitted, self-rated patient satisfaction at the Emergency Department and
at follow-up, health condition at follow-up, health consumption and
mortality at six week and two year follow-up. Diagnostic accuracy and
need of further examinations and admissions were measured in specific
subgroups as well as timing of surgery among patients with peritonitis.
Results
Several benefits were seen in the group receiving US. Diagnostic accuracy
was significantly higher in the group examined with ultrasound (65%
versus 57%, p=0.027). The number of ordered complementary US examinations
was considerably higher in the group who did not receive bedside US (9%
versus 28%, p < 0.001). The admission rate was lower in the ultrasound
group (43% versus 50%, p = 0.04) and the proportion of patients requiring
surgery submitted for surgery directly from the emergency department was
higher in the ultrasound group (34% versus 16%, p = 0.01). Self-rated
patient satisfaction was slightly higher in the ultrasound group when
leaving the emergency department but equal after six weeks. There was no
difference found in the two-year health consumption or mortality between
the groups.
Regarding sub group analyses increased diagnostic accuracy of bedside US
was seen in the patients with Body Mass Index>25(67% versus 54%, p=0.02),
elevated C-reactive protein (63% versus 52%,p=0.047), peritonitis (74%
versus 54%, age 30-59 years(68% versus 58%, p=0.042) and/or upper
abdominal pain(72% versus 52%, p=0.045). Other benefits such as decreased
need of further examinations and/or fewer admissions were seen in all
groups except the patients with a first diagnosis of appendicitis where
the outcomes were equal between the intervention groups. Among patients
with peritonitis admitted for surgery the decision about surgery was
taken while still at the emergency department for 61 % in the ultrasound
group and 19 % in the control group, p= 0.003.
Conclusion
The results we have shown in our large randomized study, following up
patients on a short- and long-term basis, is that US performed bedside by
the surgeon on duty when a patient seeks care for abdominal pain, can
increase diagnostic accuracy, decrease the need of further examinations,
decrease admission frequency and increase self-rated patient
satisfaction. There are benefits of different kinds in nearly all
subgroups and the health consumption and mortality on a long term basis
are equal. The method is well worth recommending for implementation as a
routine for evaluation of the acute abdomen in the ED