Anaesthesiologists' clinical judgment accuracy regarding preoperative full stomach: Diagnostic study in urgent surgical adult patients

Louis Delamarre; Mohamed Srairi; Lionel Bouvet; Jean-Marie Conil; Olivier Fourcade; Vincent Minville

doi:10.1016/j.accpm.2021.100836

Anaesthesiologists' clinical judgment accuracy regarding preoperative full stomach: Diagnostic study in urgent surgical adult patients

Anaesth Crit Care Pain Med. 2021 Jun;40(3):100836. doi: 10.1016/j.accpm.2021.100836. Epub 2021 Mar 19.

Authors

Louis Delamarre¹, Mohamed Srairi², Lionel Bouvet³, Jean-Marie Conil², Olivier Fourcade², Vincent Minville²

Affiliations

¹ Department of Anaesthesiology and Intensive Care, Pierre Paul Riquet Hospital, University Hospital of Toulouse, University Toulouse-3 Paul Sabatier, 31059 Toulouse, France. Electronic address: delamarre.l@chu-toulouse.fr.
² Department of Anaesthesiology and Intensive Care, Pierre Paul Riquet Hospital, University Hospital of Toulouse, University Toulouse-3 Paul Sabatier, 31059 Toulouse, France.
³ Department of Anaesthesiology and Intensive Care, Hospices Civils de Lyon, Groupement Hospitalier Est - Hôpital Femme Mère Enfant, 69500 Bron, France.

PMID: 33753294
DOI: 10.1016/j.accpm.2021.100836

Abstract

Background: In urgent situations, preoperative full stomach assessment mostly relies on clinical judgment. Our primary objective was to assess the diagnostic performance of clinical judgment for the preoperative assessment of full stomach in urgent patients compared to gastric point-of-care ultrasound (PoCUS). Our secondary objective was to identify risk factors associated with PoCUS full stomach in urgent patients.

Methods: We led a prospective observational study at our Hospital, between January and July 2016. Adult patients admitted for urgent surgery were eligible. Patients with altered gastric sonoanatomy, interventions reducing stomach content, impossible lateral decubitus were excluded. Clinical judgment and risk factors of full stomach were collected before gastric PoCUS measurements. Ultrasonographic full stomach was defined by solid contents or liquid volume ≥ 1.5 ml kg^-1. Diagnostic performance was assessed through sensitivity, specificity, accuracy, positive and negative predictive value.

Results: The prevalence of clinical and PoCUS full stomach in 196 included patients was 29% and 27%, respectively. Positive and negative predictive values were 42% (95% CI: 32.3-52.6%) and 79% (95% CI: 74.9-83.4%), respectively. Patients with PoCUS full stomach were clinically misdiagnosed in 55% of cases. PoCUS full stomach was associated with abdominal or gynaecological-obstetrical surgery (OR 3.6, 95% CI: 1.5-8.8, P < 0.01) but not with fasting durations. Positive solid intake after illness onset with respect to 6-h solid fasting rule was associated with PoCUS low-risk gastric content (OR 0.4, 95% CI: 0.2-0.9, P = 0.03).

Conclusions: Clinical judgment showed poor-to-moderate performance in urgent surgical patients for the diagnosis of full stomach. Gastric PoCUS should be used to assess risk of full stomach in this population.

Keywords: Anaesthesia complications; Emergency surgery; Gastric PoCUS pulmonary aspiration; Gastric ultrasonography; Stomach contents.

Publication types

Observational Study

MeSH terms

Adult
Emergency Service, Hospital
Gastrointestinal Contents / diagnostic imaging
Humans
Judgment*
Point-of-Care Systems*
Stomach / diagnostic imaging
Ultrasonography