EM - ORIGINAL The role of ultrasonography in the diagnosis and management of non-traumatic acute abdominal pain Mehmet Selim Nural Meltem Ceyhan Ahmet Baydin Selim Genc Ilkay Koray Bayrak Muzaffer Elmali Received: 31 December 2007 / Accepted: 3 April 2008 / Published online: 29 April 2008 Ó SIMI 2008 Abstract Our aim was to assess the effects of initial ultrasonography (US) evaluation on the diagnosis and management of non-traumatic acute abdominal pain in the emergency department. Three hundred patients with the complaint of non-traumatic acute abdominal pain who were sent for US examination with an initial clinical impression were included in the study. Pre-US and post-US surveys were designed for the clinicians who requested US. The percentage concordance of US findings with the dis- charge diagnosis made by clinical follow-up, imaging modalities and surgery was determined by calculating the confidence interval. The concordance of the initial clinical impression and the US diagnosis with the discharge diag- nosis were compared using the McNemar test. US could not detect any pathology in 102 (34%; 95%CI, 28.6– 39.3%) of the patients. The US revealed a different diag- nosis than the clinical impression in 69 (23%; 95%CI, 18.2–27.7%), and confirmed the diagnosis in 121 (40%; 95%CI, 34.4–45.5%) patients. The US changed the treat- ment plans in 47% (95%CI, 41.3–52.6%) of the patients. The clinicians stated US helped them ‘‘very much’’ or ‘‘moderately’’ in making a diagnosis in 83% (95%CI, 78.7– 87.2%). When US results were compared with the dis- charge diagnosis, there was concordance in 238 (79.3%; 95%CI, 74.3–83.6%) patients but not in 62 (20.6%; 95%CI, 16–25.1%). Among 121 patients the initial clinical impression agreed with the US diagnosis and there was concordance with the discharge diagnosis in 105 (86.7%; 95%CI, 80–92.7%). The concordance of US findings with the discharge diagnosis was significantly higher than that of the initial clinical impression statistically. In the initial evaluation of the patients with acute abdominal pain, US is considerably helpful in making the correct diagnosis, and that the concordance with the discharge diagnosis is high. When whole abdominal scanning is not performed, tar- geted US study according to the initial clinical impression decreases the clinical benefit of US. Keywords Ultrasonography Á Acute abdomen Á Making decision Á Emergency department Introduction Acute abdominal pain is one of the most frequent causes of emergency department (ED) admission and accounts for 4–5% of all ED patients [1]. Acute abdominal pain can be either surgical or medical, in origin, so effective treatment is dependent upon correct diagnosis. The acute abdomen has a broad spectrum of causes ranging from benign self- limiting conditions to diseases with high morbidity and mortality [2, 3]. Therefore, early diagnosis and treatment are important. Although the history, physical examination and laboratory tests are the main steps used to make a diagnosis, they are not always reliable. Ultrasonography (US) is not invasive, requires neither radiation nor a con- trast agent and is a readily available, repeatable, cheap and rapid method of investigation. These features make it a desirable initial imaging evaluation to attempt to reach a diagnosis following the initial clinical evaluations. Various etiologies of acute abdominal pain can easily be detected with computerized tomography (CT scan). The M. S. Nural (&) Á M. Ceyhan Á I. K. Bayrak Á M. Elmali Department of Radiology, Faculty of Medicine, Ondokuz Mayis University, Kurupelit, 55139 Samsun, Turkey e-mail: msnural@omu.edu.tr A. Baydin Á S. Genc Department of Emergency Medicine, Faculty of Medicine, Ondokuz Mayis University, Samsun, Turkey 123 Intern Emerg Med (2008) 3:349–354 DOI 10.1007/s11739-008-0157-8