title: A preliminary evaluation of emergency ultrasound in the setting of an emergency medicine training program.
abstract: In this article we seek to evaluate the diagnostic accuracy of emergency physicians performing emergency ultrasonography in the setting of an emergency medicine training program. A prospective observational study was performed at an inner city Level I trauma center with an emergency medicine residency training program. From July 1994 to December 1996 a convenience sample of ultrasound exams was recorded. The diagnostic quality ("acceptable or technically limited") was determined by a board-certified cardiologist or radiologist with fellowship training in ultrasonography. The emergency department interpretations were then compared to those of the blinded cardiologist or radiologist. Four hundred and fifty-six ultrasound examinations were videotaped and entered into the study; 408 (89%) of the studies performed were determined to be "acceptable." The diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of these studies were as follows: cardiac, to rule out effusion (n = 67; 0.83, 0.98, 0.88, 0.98); transabdominal, to rule out abdominal aortic aneurysms (AAA), cholelithiasis, or free peritoneal fluid (n = 263; 0.91, 0.89, 0.88, 0.92); renal, to rule out hydronephrosis (n = 45; 0.94, 0.96, 0.94, 0.96); pelvic, to rule in intrauterine pregnancy (n = 33; 1.0, 0.90, 0.96, 1.0). The 48 "technically limited studies" included: 39 transabdominal (33 gallbladder, 1 abdominal aortic aneurysm, 5 free peritoneal fluid), 6 cardiac, 2 renal, and 1 pelvic ultrasound. This study suggests that emergency physicians with a minimal amount of training display acceptable technical skill and interpretive acumen in their approach to emergency ultrasonography.
authors.affiliation: Department of Emergency Medicine, Lincoln Medical and Mental Health Center, New York, NY, USA. RichLanoix@aol.com
authors.forename: R
authors.initials: R
authors.lastname: Lanoix
authors.forename: L V
authors.initials: LV
authors.lastname: Leak
authors.forename: T
authors.initials: T
authors.lastname: Gaeta
authors.forename: J R
authors.initials: JR
authors.lastname: Gernsheimer
mesh_terms: D002983:Clinical Competence / Q000592:standards*; D004502:Education, Medical, Continuing; D004503:Education, Medical, Graduate; D004635:Emergency Medicine / Q000193:education*; D004638:Emergency Treatment / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D006801:Humans; D007396:Internship and Residency; D008505:Medical Staff, Hospital / Q000193:education*; D018579:Patient Selection; D019095:Point-of-Care Systems / Q000592:standards; D015397:Program Evaluation; D011446:Prospective Studies; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014193:Trauma Centers; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods / Q000592:standards*; D014743:Videotape Recording