DIAGNOSTIC ACCURACY OF BEDSIDE ULTRASONOGRAPHY COMPARED WITH DEPARTMENTAL ULTRASONOGRAPHY FOR ACUTE CHOLECYSTITIS IN A PAKISTANI TERTIARY-CARE EMERGENCY DEPARTMENT

Abstract

Background. Acute cholecystitis is a common surgical emergency requiring rapid imaging confirmation. Departmental ultrasonography is the reference standard but is frequently delayed in busy or resource-constrained emergency departments (EDs). Point-of-care ultrasound (POCUS) performed by emergency physician’s offers a faster alternative, but local validation in Pakistan is sparse. Objective. To evaluate the diagnostic accuracy of bedside ultrasonography for acute cholecystitis against departmental ultrasonography as the gold standard. Methods. A cross-sectional analytical study enrolled 138 adults presenting with right upper quadrant or epigastric pain to the ED of Dr. Ziauddin Hospital, Karachi. Bedside ultrasonography was performed by emergency physicians/residents using a standardized RUQ protocol; departmental ultrasonography was performed independently by radiologists, blinded to bedside findings. Sensitivity, specificity, predictive values, accuracy, Cohen’s κ, and 95% Wilson confidence intervals were computed. Subgroup analyses examined gender, age, and diabetes status. Results. Mean age was 44.2 ± 13.6 years; 62.3% were female and 30.4% had diabetes. Departmental ultrasonography confirmed acute cholecystitis in 110/138 patients (79.7%). Bedside ultrasonography yielded a sensitivity of 89.1% (95% CI 81.9–93.6), specificity of 78.6% (60.5–89.8), PPV 94.2%, NPV 64.7%, and overall accuracy 87.0%. Cohen’s κ was 0.627 (substantial agreement). Performance was comparable across gender (p = 0.91) and age (p = 0.62) and modestly lower in diabetics (83.3% vs 88.5%; p = 0.40). Mean time-to-scan was 12 ± 6 minutes for POCUS versus 85 ± 40 minutes for departmental imaging. Conclusion. Bedside ultrasonography performed by emergency physicians is a sensitive, accurate, and substantially faster diagnostic tool for acute cholecystitis in a Pakistani tertiary ED. POCUS does not replace departmental imaging particularly for advanced complications but its operational advantages support wider integration into emergency medicine training and practice in resource-limited settings.