Abdominal Pain Management and Point-of-care Ultrasound in the Emergency Department: A Randomised, Prospective, Controlled Study

Abstract

Objective: To determine the effect of point-of-care ultrasound (POCUS) performed during the initial evaluation phase of patients with acute abdominal pain.

Study design: Randomised controlled, parallel-group trial.

Place and duration of study: Sakarya University Training and Research Hospital, Sakarya, Turkey, from October 2019 to March 2020.

Methodology: Patients who presented to the Emergency Department (ED) with acute abdominal pain were included in the study. Exclusion criteria were permanent mental disability, age <18 years, abdominal trauma within the last 24 hours, pregnancy, morbid obesity, repeated admissions, referral from an external centre to the ED, and missing patient information. Patients were divided randomly into two groups: The control group where standard diagnostic strategies were applied and the POCUS group where POCUS was performed together with standard diagnostic strategies. The length of stay (LOS), differential diagnoses, cost and hospitalisation or discharge from ED were compared.

Results: The application of POCUS reduced the average number of preliminary differential diagnoses from four to two (p <0.001). Regarding patient outcomes, POCUS reduced LOS in ED in both the discharged and hospitalised patients (p = 0.003, and p = 0.049, respectively). In all patients, POCUS reduced LOS in ED but led to no significant changes in cost (p <0.001, p = and 0.403, respectively).

Conclusion: POCUS in patients with acute abdominal pain is very useful in reducing the number of differential diagnoses and LOS in ED.

Key words: Abdominal pain, Cost, Emergency department, Length of stay, Point-of-care ultrasound.