Influence of Clinical Context on Emergency Medicine Residents' Interpretation of Gallbladder Ultrasound Images: A Pilot Analysis.

Abstract

Introduction: Clinical ultrasound is an essential tool for emergency medicine practitioners. It is particularly useful for evaluating abdominal pain to detect the presence of gallstones or to identify other signs compatible with the diagnosis of biliary colic or cholecystitis. Although these signs are well-defined in the literature, the influence of clinical context on ultrasound interpretation has not yet been studied. The primary objective of this study is to evaluate the impact of clinical context on emergency medicine residents' interpretation of clinical ultrasound images of normal and pathological gallbladders.

Materials and methods: This prospective observational pilot study was conducted from May to September 2023 with emergency medicine residents from three Belgian universities. Participants watched a 45-min tutorial video on clinical gallbladder ultrasound and then completed a multiple-choice questionnaire consisting of 40 dynamic ultrasound loop images, 20 without clinical context and the same 20 images with written descriptions of the clinical context. Paired Student's t-test was performed to compare diagnostic performances with and without clinical context.

Results: Overall, 23 participants completed the study, with 920 ultrasound loops being analyzed. The inclusion of clinical context significantly improved the overall diagnostic performance and especially the diagnosis of acute cholecystitis (p = 0.0309 and p = 0.0164, respectively). The overall sensitivity and specificity without clinical context were 0.74 (95% CI, 0.69-0.79) and 0.82 (95% CI, 0.76-0.87) respectively, and 0.79 (95% CI, 0.74-0.84) and 0.84 (95% CI, 0.79-0.90) with clinical context. In the subgroup of acute cholecystitis, sensitivity and specificity without clinical context were 0.56 (95% CI, 0.44-0.67) and 0.97 (95% CI, 0.95-0.99) respectively, and 0.78 (95% CI, 0.68-0.88) and 0.97 (95% CI, 0.95-0.99) with clinical context.

Conclusion: The integration of clinical context appears to positively influence the interpretation of gallbladder ultrasound images, thereby enhancing diagnostic performance, especially sensitivity and particularly in the case of acute cholecystitis.