Association of point-of-care ultrasound with time-to-CT for patients undergoing acute high-risk abdominal surgery

Acute high-risk abdominal surgery (AHA) comprises a population of patients with perforated hollow viscus, intestinal obstruction or intestinal ischemia and carry high mortality and morbidity. With a coordinated effort it has been shown that the 30-day mortality can be reduced to 11,8%. The initial step is identifying the AHA-patients to facilitate early CT and surgery. This remains an ongoing challenge in the emergency department since up to 40% of the AHA-patients present with symptoms that direct them in other directions than surgical evaluation. Point of care ultrasound (POCUS) has been shown to shorten length of stay for other surgical patients. In this study we investigate if POCUS was associated with time-to-CT for AHA-patients. All consecutive AHA-patients who were operated within 24 h after hospital contact and had a CT performed before surgery were audited during a 4-year period from January 1st, 2021, to December 31st, 2024. Time-to-CT and POCUS use were recorded. 660 patients were included, where 205 underwent POCUS and 455 did not. Time-to-CT was shorter in the POCUS-group with a median time of 2.25 h compared to 3.10 h in the non-POCUS-group ( p < 0.001). Analysis with Run-charts shows that the reduced door-to-CT time shows non-random change. Abdominal POCUS performed in the emergency department was associated with a significantly shorter time-to-CT for AHA-patients.