Internistische Sonografie des Abdomens für Notaufnahmepatienten: Bietet eine vollständige Abdominalsonografie Vorteile?

Zusammenfassung

Einleitung Sollten Notaufnahmepatienten mit bauchbezogenen Beschwerden einer fokussierten Sonografie zugeführt werden oder bietet eine vollständige Abdominalsonografie Vorteile?

Methoden Retrospektive Analyse konsekutiver Notfallsonografien von 06/2012 bis 06/2013. Alle Patienten erhielten eine vollständige Abdominalsonografie. Die Befunde der vollständigen Sonografie wurden mit denjenigen verglichen, die eine auf die Beschwerden fokussierte Sonografie detektiert hätte, deren Untersuchungsgebiet von der jeweiligen Indikation abhing. Befunde wurden als relevant betrachtet, wenn sie zu diagnostischen oder therapeutischen Konsequenzen führten.

Es wurden Sensitivität und negativ prädiktiver Wert der fokussierten Sonografie bezogen auf relevante Befunde und geklärte Fragestellungen im Vergleich zur Abdominalsonografie (= Standard) berechnet.

Ergebnisse 629 Patienten erhielten Notfallsonografien (53 % Frauen). Das durchschnittliche Alter betrug 59 Jahre (18–97). Die fokussierte Sonografie entdeckte bei 63 % der Patienten (396/629) relevante Befunde. Bei 17 % (106/629) führte die vollständige Abdominalsonografie zu zusätzlichen relevanten Befunden. Die number needed to scan (NNScan) betrug 6 für einen zusätzlichen relevanten Befund. Die Sensitivität der fokussierten Sonografie bezüglich relevanter Befunde betrug 76 %, der negativ prädiktive Wert lag bei 64 %. Die Fragestellung konnte durch die fokussierte Sonografie in 57 % geklärt werden. Vollständige Sonografien klärten die Fragestellung in 63 %. Die NNScan lag bei 18.

Die Klärung der Fragestellung hing von der Indikation ab (90 % bei Ikterus und 45 % bei Schmerzen im linken oberen Quadranten) und nahm mit dem Alter der Patienten zu (37 % in der zweiten und 85 % in der zehnten Dekade).

Diskussion Vollständige Abdominalsonografien entdecken bei Notaufnahmepatienten mit bauchbezogenen Beschwerden mehr relevante Befunde und führen häufiger zu einer Klärung der Fragestellung als fokussierte Sonografien.

Abstract

Purpose To determine, whether in case of abdominal emergencies, complete abdominal ultrasound scans offer advantages over a goal-directed strategy in regard to problem-solving and detection of relevant pathologies.

Material and Methods Retrospective analysis of consecutive emergency exams that were ordered by the ER in our gastroenterological sonography unit from 06/2012 to 06/2013. All patients got an ultrasound of the complete abdomen.

We compared the findings of the complete abdomen study with the findings of a hypothetical focused sonography. The scope of the focused sonography depended on the presenting problem. An ultrasound finding was classified as relevant, if it triggered diagnostic or therapeutic consequences.

Sensitivity and negative predictive value of the goal-directed strategy were calculated with the full abdominal scan as reference.

Results 629 patients (53 % female), with an average age of 59 years (18–97) had emergency sonographies.

Focused sonography detected relevant pathologies in 63 % (396/629) of patients. In 17 % of patients (106/629) complete abdominal ultrasound led to additional relevant findings. This translates into a number needed to scan for relevant pathologies of 6. Focused sonography had a sensitivity of 76 % and a negative predictive value of 64 % for relevant pathologies.

The problem could be solved by 57 % of focused sonographies, whereas complete abdominal scans solved the problem in 63 % for a number needed to scan of 18. Sensitivity and negative predictive value of focused sonography were 87 % and 63 % respectively.

The rate of problem-solving-scans depended on the indication (with jaundice having the highest (90 %) and left-upper-quadrant pain having the lowest (45 %) rate) and increased with age (37 % for the second decade up to 85 % for the 10^th decade).

Conclusion In medical abdominal emergencies, ultrasound scans of the complete abdomen detect more relevant pathologies and solve more problems than focused sonography does.

Schlüsselwörter

Notfallsonografie - Abdominalsonografie - fokussierte Sonografie - Notaufnahme - Bauchschmerzen

Key words

emergency sonography - abdominal sonography - focused sonography - emergency room - abdominal pain

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