Am J Emerg Med. 2025 Nov 24;100:107-113. doi: 10.1016/j.ajem.2025.11.026. Online ahead of print.

INTRODUCTION: Recognizing gastric distention is important for preprocedural aspiration risk stratification. We sought to determine the diagnostic performance of coronal and sagittal ultrasound views for identifying gastric distention in the Emergency Department (ED) setting, using computed tomography (CT) as the reference standard.

METHODS: This was a single-site, prospective cohort study of adult ED patients receiving abdominal CT from 6/1/2024-6/30/2024. Prior gastric surgery or hiatal hernia were exclusion criteria. Trained investigators performed a gastric ultrasound, obtaining sagittal and coronal views. Two blinded emergency physicians independently reviewed ultrasound images for quality, antral dimensions (sagittal), and stomach appearance (sagittal and coronal). Sagittal antral dimensions were used to calculate gastric volume (GV). Sonographic gastric distention was defined as GV exceeding 1.5 mL/kg (sagittal) or visualization of a fluid-filled stomach with «starry night» appearance (coronal). The reference standard for gastric distention was gastric distention on CT. A Cohen’s kappa (κ), comparison of proportions, and test characteristics were calculated.

RESULTS: Of 230 consenting adults who underwent CT imaging, 12 were excluded, and 42 had inadequate images, leaving 176 for analysis. Of these, 51 (29.0 %) had gastric distention on CT. Agreement among emergency physicians for distention was fair for sagittal (κ = 0.29, 95 % CI 0.04-0.61 for dimensions; κ = 0.35, 95 % CI 0.05-0.65 for appearance) and almost perfect for coronal (κ = 0.85, 95 % CI 0.75-0.95). Sagittal ultrasound detected 2/51 (3.9 %) patients with gastric distention, whereas coronal ultrasound detected 19/51 (37.3 %), p < 0.001.

CONCLUSION: In the ED, visualization of a fluid-filled stomach on coronal ultrasound resulted in higher detection of gastric distention than sagittal views.

PubMed:41317460 | DOI:10.1016/j.ajem.2025.11.026