Initial accuracy of bedside ultrasound performed by emergency physicians for multiple indications after a short training period.
OBJECTIVE
Emergency physician-performed ultrasonography holds promise as a rapid and accurate method to diagnose multiple diseases in the emergency department (ED). Our objective was to assess the initial diagnostic accuracy (first 55 explorations) of emergency physician-performed ultrasonography for multiple categories of ultrasound use after a short training period.


METHODS
This was a prospective observational study conducted at an urban ED from June 2010 to March 2011 in patients with suspected cholecystitis, hydronephrosis, deep vein thrombosis, and different cardiovascular problems. Five physicians had a 10-hour training session before enrolling patients. The test characteristics of bedside ultrasonography were determined with the final radiologist/cardiologist interpretation.


RESULTS
A total of 275 ultrasonographic examinations were performed (78 abdominal explorations, 80 renal explorations, 76 2-point compression ultrasonographic examinations in patients with suspected deep vein thrombosis, and 41 echocardiograms in patients with different acute cardiovascular problems). Radiologists/cardiologists detected 28 cases of cholecystitis, 26 cases of deep vein thrombosis, 49 cases of hydronephrosis, and 15 cases of significant cardiovascular alterations. The overall diagnostic accuracy of ED ultrasonograms yielded a sensitivity, specificity, positive predictive value, and negative predictive value of 92.6% (95% confidence interval [CI], 90%-99%), 89% (95% CI, 84%-94%), 86.2 % (95% CI, 82%-93%), and 94.2% (95% CI, 92%-99%), respectively. Nineteen (6.9%) false-positive results and 6 false-negative results (2.1%) were obtained.


CONCLUSIONS
Emergency physicians in our institution attained reasonably high initial accuracy in the performance of ultrasonography for a variety of clinical problems after a 10-hour training period.
Emergency Department, Hospital Infanta Cristina, Parla, Madrid, Spain. jtorresmacho@hotmail.com
Juan
J
Torres-Macho
Juan M
JM
Antón-Santos
Isabel
I
García-Gutierrez
María
M
de Castro-García
Sergio
S
Gámez-Díez
Pilar García
PG
de la Torre
Gonzalo
G
Latorre-Barcenilla
Yolanda
Y
Majo-Carbajo
Juan C
JC
Reparaz-González
Gonzalo García
GG
de Casasola
D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging; D002764:Cholecystitis / Q000000981:diagnostic imaging; D004636:Emergency Service, Hospital / Q000592:standards; D005260:Female; D006801:Humans; D006869:Hydronephrosis / Q000000981:diagnostic imaging; D008297:Male; D019095:Point-of-Care Systems; D011446:Prospective Studies; D014463:Ultrasonography; D020246:Venous Thrombosis / Q000000981:diagnostic imaging