Pneumoperitoneum Clinical Trial
Official title:
Accuracy of Ultrasonography for the Diagnosis of Pneumoperitoneum in the Emergency Department
Pneumoperitoneum could be due to life threatening conditions and its quickly diagnosis is
important in the emergency department (ED). Signs and symptoms are non-specific and
radiography has low accuracy in the acute setting. Computed tomography (CT) is considered
the gold standard, however it is not a cost-effective option in the vast population of
patients with abdominal pain. Ultrasonography is able to detect as little as 2 ml of free
air, however diagnostic accuracy of ultrasonography remains unclear. This study evaluates
the accuracy of ultrasonography for the diagnosis of pneumoperitoneum, the most accurate
abdominal scan and the most accurate echographic sign for the detection of free air.
Methods Consecutive patients presenting to ED for acute abdominal pain and with a diagnosis
of pneumoperitoneum at CT or at surgery (study group) and a similar number of patients
without a diagnosis of pneumoperitoneum (control group) undergo abdominal ultrasonography in
a standardized protocol that include 10 scans for each patient registered on a video of 5
seconds. The videos are randomly reviewed by 4 sonographers and by 2 physicians with no
experience in ultrasonography blind to final diagnosis and to all clinical data with the aim
of detecting for each scan pneumoperitoneum. Accuracy of ultrasonography for the diagnosis
of pneumoperitoneum will be calculated considering CT or surgery as gold standard.
Furthermore intra and interobserver agreement and the accuracy of each ultrasonographic sign
and scan will be calculated.
n/a
Observational Model: Case Control, Time Perspective: Cross-Sectional
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