Pre-Ultrasound Opioids Increase False-Negative Diagnoses of AC

Background: Acute cholecystitis (AC) is relatively common in the Western world, and >700,000 cholecystectomies are performed annually in the United States. These patients typically present with right upper quadrant (RUQ) pain, and emergency physicians use a combination of patient history, physical examination, laboratory tests, and imaging to determine a diagnosis, but, unfortunately, no single laboratory, physical examination, or imaging finding can reliably rule in or rule out AC. The combination of gallstones and a positive sonographic Murphy sign (SMS) has been shown to have a 92% positive predictive value for the diagnosis. However, controversy exists regarding the role of analgesia prior to RUQ ultrasound (RUQUS) in the setting of abdominal pain when evaluating for AC. Objective: To evaluate the effect of opioid analgesia (OA) and nonopioid analgesia (NOA) on the SMS and the radiologic accuracy of diagnosing AC. Design: Retrospective cohort chart review. Methods: 686 adult pati more...