Accuracy of Spleen Measurement by Medical Residents Using Hand-Carried Ultrasound.
OBJECTIVE
Easily palpable splenomegaly can be identified on physical examination, but it is difficult to detect lesser degrees of splenomegaly. Rapid bedside assessment can be conducted with hand-carried ultrasound. We performed this study to determine whether medical residents could reliably assess spleen size using hand-carried ultrasound after a brief educational intervention.


METHODS
Postgraduate year 1 internal medicine residents were shown a brief (45-minute) presentation on ultrasound basics, the use of hand-carried ultrasound, and principles of splenic ultrasound imaging. They practiced on each other, using hand-carried ultrasound to assess spleen size, for 1 hour in the presence of an instructor. Patients with varying degrees of splenomegaly and hospital staff were recruited at Vancouver General Hospital. A sonographer measured spleen size in each participant using conventional ultrasound. Subsequently, the trained residents scanned the participants using hand-carried ultrasound, blinded to the sonographer's measurements and the participants' diagnoses. The instructor was not present during scanning.


RESULTS
Twelve first-year residents (8 male and 4 female; mean age ± SEM, 28 ± 1 years; all with limited prior ultrasound training) and 19 patients and staff members (10 male and 9 female; mean age, 60 ± 4 years; body mass index, 24 ± 2 kg/m(2)) were recruited. The greatest longitudinal measurements were 14.0 ± 0.7 cm with conventional ultrasound administered by the sonographer and 13.2 ± 0.9 cm with hand-carried ultrasound administered by the residents (P > .05, not significant). The correlation between conventional and hand-carried ultrasound was r = 0.81 (P < .001).


CONCLUSIONS
Internal medicine residents can reliably assess spleen size at the point of care using hand-carried ultrasound with minimal training. Our findings, if replicated in other centers and in different clinical scenarios, may change the way that clinicians examine the spleen.
Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Shane
S
Arishenkoff
Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Christopher
C
Eddy
Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
J Mark
JM
Roberts
Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Luke
L
Chen
Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Silvia
S
Chang
Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Parvathy
P
Nair
Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Rose
R
Hatala
Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada.
Kevin W
KW
Eva
Departments of Medicine and Radiology and Center for Health Education Scholarship, Vancouver Hospital and University of British Columbia, Vancouver, British Columbia, Canada. meneilly@mail.ubc.ca.
Graydon S
GS
Meneilly
D000328:Adult; D001955:British Columbia / Q000453:epidemiology; D002983:Clinical Competence / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D008904:Miniaturization; D009929:Organ Size; D000067716:Point-of-Care Testing / Q000706:statistics & numerical data; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013154:Spleen / Q000000981:diagnostic imaging*; D013163:Splenomegaly / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014463:Ultrasonography / Q000295:instrumentation / Q000379:methods / Q000706:statistics & numerical data*
Vscan; hand-carried ultrasound; spleen; ultrasound; ultrasound education