Key result
Emergency ultrasound of the abdominal aorta by emergency physicians accurately identified AAA with 100% sensitivity (95% CI 89.5-100) and 98% specificity (95% CI 92.8-99.8).
Why the study?
Does emergency ultrasound of the abdominal aorta by emergency physicians accurately determine the presence of abdominal aortic aneurysm in symptomatic ED patients?
Observational (n=125)
No
Does emergency ultrasound of the abdominal aorta by emergency physicians accurately determine the presence of abdominal aortic aneurysm in symptomatic ED patients?
Effect estimate: Sensitivity 100%, Specificity 98% (95% CI 89.5-100 (Sensitivity), 92.8-99.8 (Specificity))
Emergency physician-performed ultrasound of the abdominal aorta is highly sensitive and specific for detecting abdominal aortic aneurysms, allowing for rapid and accurate triage in the ED.
May support rapid ED triage for symptomatic AAA; leaves open prospective validation before practice change.
Determination of the presence of an abdominal aortic aneurysm (AAA) is essential in the management of the symptomatic emergency department (ED) patient. Objectives: To identify whether emergency ultrasound of the abdominal aorta (EUS‐AA) by emergency physicians could accurately determine the presence of AAA and guide ED disposition. Methods: This was a prospective, observational study at an urban ED with more than 100,000 annual patient visits with consecutive patients enrolled over a two‐year period. All patients suspected to have AAA underwent standard ED evaluation consisting of EUS‐AA, followed by a confirmatory imaging study or laparotomy. AAA was defined as any measured diameter greater than 3 cm. Demographic data, results of confirmatory testing, and patient outcome were collected by retrospective review. Results: A total of 125 patients had EUS‐AA performed over a two‐year period. The patient population had the following characteristics: average age 66 years, male 54%, hypertension 56%, coronary artery disease 39%, diabetes 22%, and peripheral vascular disease 14%. Confirmatory tests included radiology ultrasound, 28/125 (22%); abdominal computed tomography, 95/125 (76%); abdominal magnetic resonance imaging, 1/125 (1%); and laparotomy, 1/125 (1%). AAA was diagnosed in 29/125 (23%); of those, 27/29 patients had AAA on confirmatory testing. EUS‐AA had 100% sensitivity (95% CI = 89.5 to 100), 98% specificity (95% CI = 92.8 to 99.8), 93% positive predictive value (27/29), and 100% negative predictive value (96/96). Admission rate for the study group overall was 70%. Immediate operative management was considered in 17 of 27 (63%) patients with AAA; ten patients were taken to the operating room. Conclusions: EUS‐AA in a symptomatic population for AAA is sensitive and specific. These data suggest that the presence of AAA on EUS‐AA should guide urgent consultation. Emergency physicians were able to exclude AAA regardless of disposition from the ED.
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Tayal et al. (2003) conducted an observational in Suspected abdominal aortic aneurysm (AAA) (n=125). Emergency ultrasound of the abdominal aorta (EUS-AA) vs. Confirmatory imaging study or laparotomy was evaluated on Accuracy of EUS-AA to determine the presence of AAA (Sensitivity 100%, Specificity 98%, 95% CI 89.5-100 (Sensitivity), 92.8-99.8 (Specificity)). Emergency ultrasound of the abdominal aorta by emergency physicians accurately identified AAA with 100% sensitivity (95% CI 89.5-100) and 98% specificity (95% CI 92.8-99.8).
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