Multicentric Point of Care UltraSound by Surgeons Trial
Multicentric Point of Care UltraSound by Surgeons Trial
Acute gallbladder pathology and acute diverticulitis are common conditions met in emergency
 departments and comprise the bulk of admissions throughout general surgical calls. Both
 entities need imagistic description to tailor further management, which may be not readily
 available at the moment of patient's presentation. These delays may lose the window of
 opportunity for timed, quality decision making and may induce increased length of stay and
 subsequent increased costs.

 Ultrasound scanning has become very popular over the last half century and the equipment has
 become more compact, of a higher quality and less expensive, which has facilitated the growth
 of point-of-care ultrasonography - POCUS - that is, ultrasound performed and interpreted by
 the clinician at the bedside. The concept of an 'ultrasound stethoscope' is rapidly moving
 from theory to reality.

 There are a number of studies and case reports that are highlighting the advantages of POCUS,
 but still common grounds need to be sought after. Some countries, like USA and Germany,
 incorporate basic ultrasound in their resident's curriculum among different specialties.

 In the author's knowledge and based on the literature, there are a few-second-to-none studies
 regarding POCUS involving strictly the surgeons. The hypothesis of this study is that,
 surgeon performed ultrasound can be as accurate as the radiologists' findings for basic
 diagnostics in the aforementioned pathology, leading to real time decision making in the
 benefit of the patient.

 The closing remark is that by learning and doing these procedures the surgeon performing
 POCUS doesn't undermine his/her radiologist colleague's authority and skill. The big picture
 is that some basic tasks are transferrable and if used in an appropriate and methodical
 manner the final common goal - the benefit of the patient - is readily achieved.
The study was accepted as a Master of Surgery Thesis by Research (MCh) at the Royal College
 of Surgeons in Ireland (RCSI)

 There will be two parallel studies done at the same time:

 1. POCUSS-1 for acute biliary disease

 2. POCUSS-2 for suspected diverticulitis

 STUDY DESIGN

 1. Patients with suspected acute biliary disease or acute diverticulitis will undergo POCUS
 performed by the surgeons enrolled in the study.

 These patients are recruited from either

 1. emergency department

 2. outpatients clinic

 3. ward consults

 2. Patients will have the procedure explained to them and then will receive a leaflet with
 the same information will be handed over. Consent will be obtained (verbal and written)
 from the patients that wish to be enrolled in the study.

 3. POCUS is performed and data recorded on REDCap®.

 4a. The same patients will have a departmental imagistic investigation (ultrasound, CT)
 reported by qualified radiologists.

 4b. In the event of emergency surgery without prior departmental imaging, POCUS will be
 compared to the intra-operative findings.

 5. Data will be collected and stored anonymously and processed with REDCap, Microsoft Excel,
 IMB SPSS, R-studio

 DISCLAIMER:

 Specific for this study, patient data will be anonymous and in line with General Data
 Protection Regulation (GDPR) (EU) 2016/679 law. Data protection is designed by default. There
 will be NO patients' personal name, surname, home address or date of birth needed or
 uploaded. Each patient will be represented by an unique identification number provided by the
 hospital. Only gender and age will be recorded as these will be necessary for the final data
 analysis and results. Once the study has finished, the data will be erased.

 The same rules will be applied in hospitals from other countries that will get involved in
 the study.
POCUS-1 Inclusion Criteria - adapted after Tokyo Guidelines 2018

 1. RUQ mass/pain/tenderness

 2. Murphy's Sign

 3. Fever

 4. Elevated WBC

 5. Elevated CRP

 6. Deranged liver function tests

 7. Jaundice

 POCUS-2 Inclusion Criteria

 1. Left iliac fossa tenderness and/or palpable mass

 2. Fever

 3. Elevated WBC

 4. Elevated CRP

 5. Peritonism - Left lower quadrant / hypogastrium

 6. Per rectum bleeding/mucus discharge

 POCUSS-1 and 2 Exclusion Criteria:

 1. Age under 18 (ethical and consent issues)

 2. Pregnancy

 3. Obesity (BMI ≥ 30)-difficulty in performing USS

 4. Previously documented gallstones within the last 2 months for non-critical
 presentations

 5. Previously documented diverticulitis within the last 2 months for non-critical
 presentations

 6. POCUS performed after official report (for training purposes)

 7. Previous colonic resection, particularly left sided or sigmoid colon.

 8. Previous cholecystectomy