Upper abdominal ultrasound in general practice: indications, diagnostic yield and consequences for patient management.
BACKGROUND
Abdominal ultrasound (US) is frequently performed in Western societies. There is insufficient knowledge of its diagnostic value in terms of changes in patient management decisions in primary care.


OBJECTIVE
To assess the influence of upper abdominal US on patient management in general practice.


METHODS
A prospective cohort study with 76 GPs and three general hospitals in The Netherlands. A total of 395 patients aged >or=18 years referred by their GPs for upper abdominal US were included. The main outcome was change in anticipated patient management assessed by means of questionnaires filled in by GPs before and after abdominal US.


RESULTS
Mean age of the patients was 54.0 +/- 15.8 years, 35% were male. Clinically relevant abnormalities were found in 29% of the abdominal US, mainly cholelithiasis. Anticipated patient management changed in 64% of the patients following abdominal US. Main changes included fewer referrals to a medical specialist (from 45 to 30%); and more frequent reassurance of the patient (from 15 to 43%). However, this reassurance was not perceived as such in almost 40% of these patients. A change in anticipated patient management occurred significantly more frequently in patients with a prior cholecystectomy (82%).


CONCLUSIONS
Anticipated patient management by the GP changed in 64% of patients following upper abdominal US. Abdominal US substantially reduced the number of intended referrals to a medical specialist, and more patients could be reassured by their GP.
Speets
Anouk M
AM
Department of Radiology, University Medical Centre Utrecht Utrecht, Utrecht, The Netherlands. a.speets@umcutrecht.nl
Hoes
Arno W
AW
van der Graaf
Yolanda
Y
Kalmijn
Sandra
S
de Wit
Niek J
NJ
van Swijndregt
Alexander D Montauban
AD
Gratama
Jan Willem C
JW
Rutten
Matthieu J C M
MJ
Mali
Willem P T H M
WP
D000005:Abdomen / Q000000981:diagnostic imaging*; D015331:Cohort Studies; D005194:Family Practice; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009426:Netherlands; D010346:Patient Care Management; D010818:Practice Patterns, Physicians'; D011446:Prospective Studies; D012017:Referral and Consultation; D014463:Ultrasonography / Q000379:methods / Q000706:statistics & numerical data