title: Accuracy of trans-abdominal ultrasound in a simulated massive acute overdose.
abstract: BACKGROUND
  Toxic ingestions are a common cause of morbidity and mortality in the United States. In 2013, there were nearly 2 million reported ingestions and nearly 1000 deaths from poisonings. There is no well-validated imaging study for confirming the presence of pills in the stomach of an overdose patient. There are case reports of ultrasound used for confirmation of pills in the stomach, and we are aware of one prospective trial to evaluate sonography for this application.
  
  
  OBJECTIVE
  To determine the sensitivity and specificity of transabdominal ultrasound for visualization of ingested pills.
  
  
  METHODS
  Randomized, blinded, placebo-controlled study. Twenty Subjects were randomized to one of two groups. The experimental group ingested 50 enteric-coated placebo capsules with 1 liter of fluid. The control group ingested only 1 liter of fluid. At time 0, 60, and 90 minutes after ingestion, expert sonographers performed transabdominal ultrasound in an attempt to visualize pills in the stomach.
  
  
  RESULTS
  At time 0, 60, and 90 minutes post-ingestion, ultrasound had a sensitivity of 62.5% (41.1%, 81.9%), 20.8% (4.6%, 37.1%), and 25% (7.7%, 42.3%) respectively. The specificity at time 0, 60, and 90 minutes post-ingestion were 58.3% (21.9%, 61.4%), 79.1% (62.9%, 95.5%), and 70.8% (52.6%, 89.0%) respectively.
  
  
  CONCLUSIONS
  There is poor sensitivity and specificity for ultrasound detection of pills in the stomach at time 0; these values fell substantially at 60 and 90 minutes post-ingestion. In this pilot study, we did not find ultrasound to be a useful screening tool for detecting pills in the stomach.
authors.affiliation: Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, WA. Electronic address: scott.b.sullivan6.mil@mail.mil.
authors.forename: Scott
authors.initials: S
authors.lastname: Sullivan
authors.affiliation: Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, WA.
authors.forename: Cameron
authors.initials: C
authors.lastname: Wolterstorff
authors.affiliation: Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, WA.
authors.forename: Jeremy
authors.initials: J
authors.lastname: Johnson
authors.affiliation: Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, WA.
authors.forename: Vincent
authors.initials: V
authors.lastname: Ball
authors.affiliation: Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, WA.
authors.forename: Carl
authors.initials: C
authors.lastname: Skinner
authors.affiliation: Madigan Army Medical Center, Department of Emergency Medicine, Tacoma, WA.
authors.forename: Jason
authors.initials: J
authors.lastname: Bothwell
mesh_terms: D000208:Acute Disease; D000328:Adult; D062787:Drug Overdose / Q000175:diagnosis*; D005260:Female; D006801:Humans; D008297:Male; D016544:Patient Simulation; D010865:Pilot Projects; D011446:Prospective Studies; D015203:Reproducibility of Results; D016037:Single-Blind Method; D013270:Stomach / Q000000981:diagnostic imaging*; D014463:Ultrasonography / Q000379:methods*