Surgeon attitudes toward point of care ultrasound for biliary disease: a nationwide Canadian survey

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Fig. 1
Number of consults per year from emergency department on the basis of point of care ultrasound for suspected biliary disease.
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Fig. 2
Confidence in diagnostic information on the basis of point of care ultrasound in patients with biliary disease.

Factor	Responses considered staff level, frequent, high sensitivity or management altering			Responses considered trainee level, infrequent, low sensitivity or not altering management
Level of training	—	Staff surgeon (> 10 years practice)	Staff surgeon (< 10 years practice)	Fellow	Senior resident (years 3–5)	Junior resident (years 1–2)
Frequency that PoCUS results are used in practice	Very often	Somewhat often	Occasionally	Rarely	Never	—
Frequency of performing PoCUS personally in practice	Very often	Somewhat often	Occasionally	Rarely	Never	—
Frequency of referrals based on PoCUS-diagnosed biliary disease	> 20 times	10–20 times	5–10 times	3–5 times	1–2 times	Never
Perceived sensitivity of PoCUS for cholelithiasis	90%–100%	80%–90%	70%–80%	60%–70%	50%–60%	< 50%
Perceived sensitivity of PoCUS for cholecystitis	90%–100%	80%–90%	70%–80%	60%–70%	50%–60%	< 50%
Ability to admit, diagnose and/or operate based on PoCUS findings	Yes, definitely	Likely yes	Maybe	Likely no	No, definitely not	—

Table 1

Clinical decision-making using biliary PoCUS

Scenario	Decision; no. (%)
Scenario	Yes, definitely	Likely yes	Maybe	Likely no	No, definitely not
A patient presents with a history consistent with unremitting biliary colic and normal blood work. Is the finding of gallstones on PoCUS enough for you to
Admit overnight for unremitting biliary colic	14 (10.9)	43 (33.3)	37 (28.7)	23 (17.8)	12 (9.3)
Diagnose biliary colic	14 (10.9)	32 (24.8)	47 (36.4)	26 (20.2)	10 (7.8)
Operate for biliary colic	6 (4.7)	9 (7.0)	15 (11.7)	31 (24.2)	67 (52.3)
A patient presents with elevated white count, RUQ pain and normal bilirubin. Are the findings of sonographic Murphy sign and gallstones on PoCUS enough for you to
Admit overnight for cholecystitis	31 (24.0)	44 (34.1)	32 (24.8)	14 (10.9)	8 (6.2)
Diagnose cholecystitis	15 (11.6)	32 (24.8)	40 (31.0)	28 (21.7)	15 (11.6)
Operate for cholecystitis	7 (5.4)	9 (7.0)	17 (13.3)	37 (28.9)	58 (45.3)

Table 2

Factors associated with level of confidence in biliary PoCUS results

Factor	χ²	p value
Frequency that PoCUS results are used in practice	3.87	0.05
Frequency that PoCUS is performed personally in practice	6.73	0.01
Level of training	0.03	0.88
Previous PoCUS training	0.73	0.39
Awareness of emergency physician use of PoCUS for biliary disease	0.34	0.56
Frequency of referrals for PoCUS-diagnosed biliary disease	1.36	0.24
Perceived sensitivity of PoCUS for cholelithiasis	7.77	0.01
Perceived sensitivity of PoCUS for cholecystitis	6.57	0.01
Concern for variability in emergency physician performing the test	0.14	0.71
Ability to replicate PoCUS test results	5.82	0.02
Availability of formal online report	3.69	0.05