1015 adult population with gallstones no symptoms

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10%–15% adult population with gallstones. No symptoms after 15 years – unlikely to develop symptoms. Provided data for defining prevalence and incidence of disease. Diagnostic ultrasound 169 Gallbladder ultrasound
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Reference Methods Results Notes 10%–18% risk of symptoms over 5–15 years. 900 000 cholecystectomies a year at cost of $5 billion. Durston et al. 2001 [ 10 ] Randomized patients to emergency department (ED) US vs. standard of care (no ED US) in undifferentiated abdominal pain. With introduction of ED sonography, diagnostic accuracy for biliary disease improved from 28% to 70%. Decrease in return visits for pain – 1.67 vs. 1.25. Decrease in complications from stones – 6.8% vs. 1.7%. Outcomes evaluation after introduction of ED sonography for the evaluation of undifferentiated abdominal pain. Kendall & Shimp 2001 [ 11 ] Compared test characteristics of emergency physician (EP)-performed and formal radiology biliary US. Cholelithiasis diagnostic sensitivity 96%, specificity 88%. Time to EP-performed study < 10 min. Further define accurate test characteristics of EP-performed study. Suggest time savings as well. Rosen et al. 2001 [ 12 ] Compared sensitivity and specificity of EP- performed vs. formal radiology biliary US for diagnosis of cholecystitis. EP sensitivity 91%, specificity 66%. Formal US sensitivity 69%, specificity 95%. First study to note increased sensitivity of EP- performed biliary US for diagnosing cholecystitis over formal study. Suggests linkage with care physician knowledge of pretest probability. Blaivas et al. 1999 [ 13 ] Compared length of stay (LOS) in patients who had EP-performed gallbladder US vs. those who had radiology-performed gallbladder US. Retrospective study. Median LOS 7% less in patients with EP- performed US. Median LOS “after hours” 15% less in patients with EP-performed US. Time savings for patients with EP- performed US. Gaspari et al. 2009 [ 14 ] Compared proportion of adequate images and agreement with expert over-read in ED scans performed by credentialed vs. non- credentialed EPs. Credentialed EPs performed technically complete scans 80% of the time; over 90% rated as excellent or good image quality. Image quality, interpretation, and proportion of scans with a complete image set all increased after 25 scans. 170 Diagnostic ultrasound Gallbladder ultrasound
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References 1. Ralls PW, Colletti PM, Lapin SA, et al. Real-time sonography in sus- pected acute cholecystitis: prospective evaluation of primary and secondary signs. Radiology 1985; 155 : 767–71. 2. Shea JA, Berlin JA, Escarce JJ, et al. Revised estimates of diagnostic test sensitivity and specificity in suspected biliary tract disease. Arch Int Med 1994; 154 : 2573–81. 3. Finberg HJ, Birnholz JC. Ultrasound evaluation of the gallbladder wall. Radiology 1979; 133 : 693–8. 4. Engel JM, Deitch EA, Sikkema W. Gallbladder wall thickness: sono- graphic accuracy and relation to disease. AJR Am J Roentgenol 1980; 134 : 907–9.
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