title: Ultrasound evaluation of blunt abdominal trauma: program implementation, initial experience, and learning curve.
abstract: OBJECTIVE
  Although sonographic screening for blunt abdominal trauma is gaining acceptance, standards for implementation, training, credentialing, and quality control remain to be established.
  
  
  METHODS
  This prospective study examines a Level I trauma service experience with the de novo establishment of a trauma ultrasound (US) program credentialed through the Department of Surgery under the auspices of Continuous Quality Improvement.
  
  
  METHODS
  All trauma surgeons attended a combined didactic and "hands on" 8-hour trauma US course. Abdominal sonography was subsequently performed on patients with potential blunt abdominal trauma followed by a standard diagnostic evaluation, which included computed tomographic scan, diagnostic peritoneal lavage, or observation.
  
  
  RESULTS
  Three hundred patients were studied over a 4-month period. They averaged 35 years of age with an average injury severity score of 12. The time required to perform the US examination averaged less than 3 minutes. Standard diagnostic evaluation included computed tomographic scan (21%), diagnostic peritoneal lavage (45%), and observation (34%). US examinations resulted in 277 true negatives, 17 true positives, two false positives, and four false negatives for a sensitivity of 81.0%, a specificity of 99.3%, and an accuracy of 98.0%. Annualized cost savings with the use of US evaluation versus standard diagnostic evaluation would amount to over $100,000.00.
  
  
  CONCLUSIONS
  This experience with the de novo implementation of a trauma US program suggests that the training and credentialing requirements in this study are sufficient to provide surgeon ultrasonographers with acceptable competence in US diagnosis of blunt abdominal trauma.
authors.affiliation: Grant Medical Center, Columbus, Ohio, USA.
authors.forename: B
authors.initials: B
authors.lastname: Thomas
authors.forename: R E
authors.initials: RE
authors.lastname: Falcone
authors.forename: D
authors.initials: D
authors.lastname: Vasquez
authors.forename: S
authors.initials: S
authors.lastname: Santanello
authors.forename: M
authors.initials: M
authors.lastname: Townsend
authors.forename: S
authors.initials: S
authors.lastname: Hockenberry
authors.forename: J
authors.initials: J
authors.lastname: Innes
authors.forename: S
authors.initials: S
authors.lastname: Wanamaker
mesh_terms: D000007:Abdominal Injuries / Q000175:diagnosis / Q000000981:diagnostic imaging*; D000328:Adult; D003363:Cost Control; D004502:Education, Medical, Continuing; D005188:False Negative Reactions; D005189:False Positive Reactions; D005260:Female; D013502:General Surgery / Q000193:education; D006801:Humans; D008297:Male; D010533:Peritoneal Lavage; D011446:Prospective Studies; D011785:Quality Assurance, Health Care; D012680:Sensitivity and Specificity; D014057:Tomography, X-Ray Computed; D014463:Ultrasonography / Q000191:economics / Q000592:standards; D014949:Wounds, Nonpenetrating / Q000175:diagnosis / Q000000981:diagnostic imaging*