Emergency department ultrasound scanning for abdominal aortic aneurysm: accessible, accurate, and advantageous.
OBJECTIVE
This study was conducted to determine whether emergency physicians with relatively limited training and experience can accurately identify the presence or absence of abdominal aortic aneurysms (AAAs) by performing bedside ultrasound scanning, and to assess the potential impact of ultrasound scanning on clinical management.


METHODS
Patients in whom AAAs were suspected, including those patients older than 50 years presenting with abdominal/back pain of unclear origin or presumed renal colic, were eligible for study entry. Consenting adults had ultrasound scanning by an emergency physician who was not responsible for their primary care. Treating physicians remained blinded to the results unless an unexpected AAAs was discovered. Scan accuracy was ascertained by comparing our ultrasound results with preselected gold standards. The clinical impact of the ultrasound studies was determined by comparing the preultrasound and postultrasound assessment sheets that detailed the presumed diagnosis, proposed investigations and therapies, and patient disposition.


RESULTS
Our convenience sample includes 68 scans for AAAs; findings of 26 scans were positive, 40 scans yielded negative findings, and 2 scans were indeterminate. Scan interpretations were 100% accurate. The ultrasound results would have improved the care of 46 patients without adverse sequelae. Ultrasound scanning served primarily to exclude AAA in patients who proved not to have aneurysms; however, scans also provided significant benefits for those with AAAs and improved patient management plans.


CONCLUSIONS
Relative neophytes can perform aortic ultrasound scans accurately. These scans appear useful as a screening measure in high-risk emergency department patients; they may also aid in rapidly verifying the diagnosis in patients who require immediate surgical intervention.
Kuhn
M
M
Departments of Emergency Medicine, and Radiology, Royal Adelaide Hospital, Adelaide, South Australia, Australia. mkuhn@mail.rah.sa.gov.au
Bonnin
R L
RL
Davey
M J
MJ
Rowland
J L
JL
Langlois
S L
SL
D015746:Abdominal Pain / Q000000981:diagnostic imaging; D000328:Adult; D000367:Age Factors; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging* / Q000601:surgery; D001416:Back Pain / Q000000981:diagnostic imaging; D003085:Colic / Q000000981:diagnostic imaging; D016001:Confidence Intervals; D004635:Emergency Medicine; D004636:Emergency Service, Hospital; D006801:Humans; D007674:Kidney Diseases / Q000000981:diagnostic imaging; D008403:Mass Screening; D008875:Middle Aged; D010347:Patient Care Planning; D019095:Point-of-Care Systems; D012307:Risk Factors; D012680:Sensitivity and Specificity; D016037:Single-Blind Method; D014463:Ultrasonography