Accuracy of colour Doppler ultrasound for nasogastric tube placement in emergency department: A prospective observational study.

OBJECTIVE

Nasogastric tube (NGT) placement is a common procedure in EDs. Successful NGT placement reduces complications such as aspiration pneumonia, pneumothorax and mortality. While chest radiography is the gold standard for confirmation, colour Doppler ultrasonography (CDU) has demonstrated high accuracy. As its applicability in the ED remains underexplored, the present study evaluates the accuracy of CDU in confirming NGT placement in the ED.

METHODS

A prospective observational study was conducted in a tertiary hospital ED from October 2022 to October 2023. Adult patients requiring NGT insertion were eligible. NGT placement was performed using a standardised protocol and confirmed with CDU and chest radiography. Accuracy of CDU was assessed against chest radiography, and procedural times for confirmation were compared using the Kruskal-Wallis H test.

RESULTS

Of 157 patients screened, 144 were included. CDU demonstrated 92.45% (95% confidence interval 85.67-96.69) sensitivity, 80.56% (63.98-91.81) specificity, positive predictive value 0.93 (0.88-0.96), negative predictive value 0.78 (0.64-0.88), positive likelihood ratio 4.75 (2.44-9.27) and negative likelihood ratio 0.09 (0.05-0.19). The median (interquartile range) confirmation times were 3.0 min (2.0-3.0) for CDU and 42.0 min (30.0-55.0) for radiography (P < 0.001).

CONCLUSION

CDU should not currently be used as a standalone method for confirming NGT placement due to its limitations and risk of false-positive results. Further research is required to address these challenges before considering its clinical implementation.