Point-of-care ultrasonography improves the diagnosis of splenomegaly in hospitalized patients

Andrew P. J. Olson, Bernard Trappey, Michael Wagner, Michael Newman, L. James Nixon, Daniel Schnobrich

It is important to detect splenomegaly as it can have important diagnostic implications. Previous studies, however, have shown that the traditional physical examination is limited in its ability to rule in or rule out splenomegaly. To determine if performing point-of-care ultrasonography (POCUS) in addition to the traditional physical examination improves the sensitivity and specificity for diagnosing splenomegaly. This was a prospective trial of diagnostic accuracy. Physical and sonographic examinations for splenomegaly were performed by students, residents and attending physicians enrolled in an ultrasound training course. Participants received less than 1 h training for ultrasound diagnosis of splenomegaly. The findings were compared to radiographic interpretation of gold standard studies. Hospitalized adult patients at an academic medical center without severe abdominal pain or recent surgery who had abdominal CT, MRI or ultrasound performed within previous 48 h. Thirty-nine subjects were enrolled. Five patients had splenomegaly (12.5 %). The physical examination for splenomegaly had a sensitivity of 40 % (95 % CI 12-77 %) and specificity of 88 % (95 % CI 74-95 %) while physical examination plus POCUS had a sensitivity of 100 % (95 % CI 57-100 %) and specificity of 74 % (95 % CI 57-85 %). Physical examination alone for splenomegaly had an LR+ of 3.4 (95 % CI 0.83-14) and LR- of 0.68 (95 % CI 0.33-1.41); for physical exam plus POCUS the LR+ was 3.8 (2.16-6.62) and LR- was 0. Point-of-care ultrasonography significantly improves examiners' sensitivity in diagnosing splenomegaly.