title: Focused assessment with sonography for trauma patients by clinicians: Initial experience and results.
abstract: OBJECTIVE
  To describe the establishment of a service to provide bedside focused assessment sonography in trauma and to evaluate the service to date.
  
  
  METHODS
  Emergency department of an urban trauma centre.
  
  
  METHODS
  A prospective study of trauma patients who received a focused assessment sonography in trauma examination performed by a clinician managing the trauma in the emergency department. Accuracy was determined by comparing the scan interpretation with abdomino-pelvic computerized tomography, laparotomy or postmortem examination.
  
  
  RESULTS
  The study period ran from 1 January 2000 to 11 September 2001 inclusive (20 months). One hundred and forty patients were included, with a final diagnosis established by computerized tomography (n = 124) and/or laparotomy (n = 18). There were 26 true-positives, 101 true-negatives, two false-positives and 11 false-negatives. Ten of the false-negative studies were performed by clinicians who had not reached accreditation. The sensitivity of focused assessment sonography in trauma was 70%, specificity 98% and diagnostic accuracy 91%.
  
  
  CONCLUSIONS
  We have described the implementation of a clinician-based focused assessment sonography in trauma service within the emergency department with the support of radiology/ultrasound and trauma service. Processes for credentialling, quality assurance and training need to be in place. Significant issues exist with the length of time it takes clinicians to reach accreditation, in order that a critical mass of clinicians exists to provide a consistent service. The credentialling process should mandate a minimum number of supervised examinations.
authors.affiliation: Department of Emergency Medicine, Division of Surgery, Westmead Hospital, Westmead, New South Wales, Australia. johnvass@ihug.com.au
authors.forename: John
authors.initials: J
authors.lastname: Vassiliadis
authors.forename: Robert
authors.initials: R
authors.lastname: Edwards
authors.forename: George
authors.initials: G
authors.lastname: Larcos
authors.forename: Kerry
authors.initials: K
authors.lastname: Hitos
mesh_terms: D002983:Clinical Competence; D003406:Credentialing; D004636:Emergency Service, Hospital / Q000592:standards*; D006801:Humans; D009517:New South Wales; D019095:Point-of-Care Systems / Q000592:standards*; D011446:Prospective Studies; D012680:Sensitivity and Specificity; D014463:Ultrasonography; D014947:Wounds and Injuries / Q000000981:diagnostic imaging*