Multi-center analysis of point-of-care ultrasound for small bowel obstruction: A systematic review and individual patient-level meta-analysis

Authors

Hamid Shokoohi, Department of Emergency Medicine, Massachusetts General Hospital- Harvard Medical School, 326 Cambridge Street, Suite 410, Boston, MA 02114, United States of America. Electronic address: hshokoohi@mgh.harvard.edu.
Katherine Dickerson Mayes, Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Boston, MA, United States of America.
Gary D. Peksa, Rush University Medical Center, Chicago, IL, United States of America.
Michael A. Loesche, Harvard Affiliated Emergency Medicine Residency, Harvard Medical School, Boston, MA, United States of America.
Brent A. Becker, Department of Emergency Medicine, Wellspan York Hospital, York, PA, United States of America.
Keith S. Boniface, Department of Emergency Medicine, George Washington University, Washington, DC, United States of America.
Shadi Lahham, Department of Emergency Medicine, The University of California at Irvine, Orange, CA, United States of America.
Timothy B. Jang, Harbor-UCLA Medical Center, Torrance, CA, United States of America.
Michael Secko, Renaissance School of Medicine, Stony Brook University Hospital, Stony Brook, NY, United States of America.
Michael Gottlieb, Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America.

Document Type

Journal Article

Publication Date

6-1-2023

Journal

The American journal of emergency medicine

Volume

70

DOI

10.1016/j.ajem.2023.05.039

Keywords

Diagnostic accuracy; Individual patient-level data; Meta-analysis; Point-of-care ultrasound (POCUS); Small bowel obstruction

Abstract

OBJECTIVE: The study aimed to assess the diagnostic accuracy of point-of-care ultrasound (POCUS) in identifying small bowel obstruction (SBO) and to investigate the impact of clinician experience level and body mass index (BMI) on POCUS performance for diagnosing SBO in the Emergency Department. METHODS: We systematically searched PubMed and Cochrane databases from January 2011-2022. We performed a meta-analysis using individual patient-level data from prospective diagnostic accuracy studies from which we obtained data from the corresponding authors. Overall test characteristics and subgroup analysis across clinician experience levels and a range of BMI were calculated. The primary outcome was SBO as the final diagnosis during hospitalization. RESULTS: We included Individual patient data from 433 patients from 5 prospective studies. Overall, 33% of patients had a final diagnosis of SBO. POCUS had 83.0% (95%CI 71.7%-90.4%) sensitivity and 93.0% (95%CI 55.3%-99.3%) specificity; LR+ was 11.9 (95%CI 1.2-114.9) and LR- was 0.2 (95%CI 0.1-0.3). Residents had exhibited a sensitivity of 73.0% (95%CI 56.6%-84.9%) and specificity of 88.2% (95%CI 58.8%-97.5%), whereas attendings had demonstrated a sensitivity of 87.7% (95%CI 71.1%-95.4%) and specificity of 91.4% (95%CI 57.4%-98.8%). Among those patients with BMI<30 kg/m, POCUS showed a sensitivity of 88.6% (95%CI 79.5%-94.7%) and a specificity of 84.0% (95%CI 75.3%-90.6%), while patients with BMI ≥ 30 kg/m exhibited a sensitivity of 72.0% (95%CI 50.6%-87.9%) and specificity of 89.5% (95%CI 75.2%-97.1%). CONCLUSIONS: POCUS correctly identified those patients with SBO with high sensitivity and specificity. Diagnostic accuracy was slightly reduced when performed by resident physicians and among patients with a BMI ≥ 30 kg/m. REGISTRATION: PROSPERO registration number: CRD42022303598.

APA Citation

Shokoohi, Hamid; Mayes, Katherine Dickerson; Peksa, Gary D.; Loesche, Michael A.; Becker, Brent A.; Boniface, Keith S.; Lahham, Shadi; Jang, Timothy B.; Secko, Michael; and Gottlieb, Michael, "Multi-center analysis of point-of-care ultrasound for small bowel obstruction: A systematic review and individual patient-level meta-analysis" (2023). GW Authored Works. Paper 2785.
https://hsrc.himmelfarb.gwu.edu/gwhpubs/2785

Department

Emergency Medicine