Does Emergency Department point-of-care ultrasound in the evaluation of possible small bowel obstruction lead to meaningful improvements in patient-centric milestones?

Abstract

Introduction: Point-of-care ultrasound (POCUS) has 90-95% sensitivity and specificity for small bowel obstruction (SBO) compared with computed tomography (CT). ED clinicians might reasonably use a positive POCUS to progress to patient-centric milestones (eg, nasogastric tube (NGT) placement, general surgery consult, and disposition). Awaiting CT performance and interpretation before moving to such milestones may delay care. Literature is limited concerning the effects of POCUS vs. CT alone on such patient-centric milestones for patients with SBO. This study compared time to patient-centric milestones (NGT, general surgery consult, and disposition) among ED patients suspected of having SBO who underwent POCUS vs. CT only in their SBO diagnostic process. Methods: Data from 11,801 SBO patients seen among 14 EDs between 2017-2022 was queried. Patients were categorized into two groups according to diagnostic method (POCUS + CT vs. CT alone). Patients were included if they had a POCUS positive for SBO and an ED diagnosis of SBO; they were excluded from analysis of any specific/particular milestone (NGT, general surgery consult, or disposition) if they had that milestone prior to POCUS. Median time from ED arrival to each milestone was calculated for both groups (POCUS + CT vs. CT alone). Results: Compared to CT-only patients, patients with POCUS plus CT had a non-statistically-significant longer wait time from ED arrival to NGT (414 vs. 390, p=0.7) and from ED arrival to general surgery consult (487.5 vs. 442 minutes, p = 0.07). They had statistically-significantly longer time to from ED arrival to disposition (475.5 vs. 377 minutes, p=0.009). Among cases in which POCUS was performed, 80% of the time the NGT was placed, 77% of the time the general surgery consult was performed, and 100% of time disposition was made only after CT result rather than after POCUS but before CT result. Conclusion: Use of POCUS was not associated with earlier achievement of patient-centric milestones (NGT or general surgery consult) and was associated with longer time to disposition. This is most-likely because, despite POCUS suggesting SBO, clinicians waited for CT results prior to placing the NGT, consulting general surgery, and entering the disposition. Such results suggest that, despite POCUS's high sensitivity and specificity, ED and/or general surgery clinicians rely on CT scan results to confirm SBO, delaying patient-centric milestones.