Diagnostic Performance of Point of Care Ultrasound to Identify Intestinal Obstruction

Overview

As reported in previous studies, Point-of-Care Ultrasound (POCUS) has good performance for the diagnosis of bowel obstruction even when compared with CT. This inexpensive, radiation-free tool is available in a majority of ED. It is performed at the patient's bedside with immediate results. The learning curve allows Emergency Physicians (EP) to perform this exam after a relative brief training period. The investigators aim to investigate the ability of POCUS performed before CT to exclude the diagnosis of bowel obstruction in patients admitted for abdominal pain.

Study Type

  • Study Type: Observational
  • Study Design
    • Time Perspective: Prospective
  • Study Primary Completion Date: May 1, 2022

Detailed Description

Bowel obstruction (BO) is frequently suspected in the Emergency Department (ED). Computed Tomography (CT) is commonly used to diagnose this disease. However, CT is not always available in real-time, requires technician times, is associated with increased cost and exposes patients to radiations. The researchers will investigate the diagnosis performances of POCUS for the diagnosis of BO with comparison with CT which will be considered as the gold standard. The wain objective will be the ability to exclude the diagnosis of BO, the main criteria being the negative predictive value. The secondary objectives will be the diagnosis performances (sensitivity, specificity, positive predictive value), duration and difficulty of POCUS

Interventions

  • Other: Point-of-Care Ultrasound
    • Patients admitted to the ED with abdominal pain and suspicion of bowel obstruction : realization of a Point-of-Care Ultrasound after clinical exam by the Emergency Physician in charge as a standard of care. Beside usual findings, the investigators will search for signs of bowel obstruction: dilated and incompressible small bowel loop, back-and-forth peristalsis sign. Determination of probability of small bowel obstruction. Realization of a computed tomography in search of small bowel obstruction.

Clinical Trial Outcome Measures

Primary Measures

  • Negative predictive value of POCUS
    • Time Frame: Through ED stay, up to 24 hours
    • Negative predictive value of POCUS for the diagnosis of bowel obstruction compared with computed tomography result

Secondary Measures

  • Positive predictive value of POCUS for the diagnosis of bowel obstruction
    • Time Frame: Through ED stay, up to 24 hours
    • Positive predictive value
  • Sensitivity of POCUS for the diagnosis of bowel obstruction
    • Time Frame: Through ED stay, up to 24 hours
    • sensitivity of POCUS, for the diagnosis of bowel obstruction compared with computed tomography result
  • Specificity of POCUS for the diagnosis of bowel obstruction
    • Time Frame: Through ED stay, up to 24 hours
    • specificity of POCUS, for the diagnosis of bowel obstruction compared with computed tomography result

Participating in This Clinical Trial

Inclusion Criteria :

  • Adult patients – Abdominal pain – Suspected bowel obstruction Exclusion Criteria : – Documented end-of-life precluding CT realization

Gender Eligibility: All

Minimum Age: 18 Years

Maximum Age: N/A

Are Healthy Volunteers Accepted: No

Investigator Details

  • Lead Sponsor
    • Nantes University Hospital
  • Provider of Information About this Clinical Study
    • Sponsor
  • Overall Contact(s)
    • Philippe LE CONTE, PhD, 33 2 40 28 39 34, philippe.leconte@chu-nantes.fr

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