Feasibility of pneumoperitoneum diagnosis using point-of-care ultrasound: A pilot study using a fresh cadaver model

• Main Authors: Carter, E. (Author), Dietrich, C.F (Author), Herbst, M.K (Author), Hoffmann, B. (Author), Wu, S. (Author)
• Format: Article
• Language: English
• Published: Societatea Romana de Ultrasonografie in Medicina si Biologie 2022
• Subjects: abdomen; Article; cadaver; Cadaver; chi square test; controlled study; diagnostic accuracy; diagnostic test accuracy study; echography; emergency medicine; Emergency medicine; emergency physician; emergency ward; Feasibility Studies; feasibility study; human; Humans; left lower quadrant; mid epigastrium; Pilot Projects; pilot study; pneumoperitoneum; Pneumoperitoneum; point of care system; point of care ultrasound; Point-of-Care Systems; Point-of-care ultrasound; sensitivity and specificity; stomach; Ultrasonography
• Online Access: View Fulltext in Publisher

 Aims: To assess the accuracy of point-of-care ultrasound (PoCUS) in the hands of two trained and blinded emergency physicians (EPs) in detecting very small amounts of free intraperitoneal air injected intra-abdominally, using a fresh human cadaver model. Material and methods: Fifteen cadavers were injected on 3 occasions with predefined quantities of free intraperitoneal air ranging from 0-10 mL. Seven cadavers were injected in the mid-epigastrium (ME), while 8 were injected in the left lower quadrant (LLQ). Each cadaver was scanned after each of the 3 injections by 2 trained and blinded EPs, resulting in 45 scans per sonographer. Scans were performed using previously validated and standardized techniques. All scans were recorded, time-stamped and labeled. For each scan the sonographers indicated “yes” or “no” to whether pneumoperitoneum was detected. A chi square analysis was performed to determine the sensitivity and specificity of PoCUS utilized by each sonographer of pneumoperitoneum based on the location and volume of air injected. Results: Free air (0.25-10 mL) injected into the ME was successfully diagnosed in 36/42 instances (86% sensitivity), but only detected in 10/36 instances when injected into the LLQ (28% sensitivity). Both EPs detected all air injections of ≥2 mL into the ME. Conclusion: Detection of free air originating from the midepigastric region may become a future PoCUS indication for adequately trained EPs. © 2022 Societatea Romana de Ultrasonografie in Medicina si Biologie. All rights reserved.