title: Inter-rater agreement between trained emergency medicine residents and radiologists in the examination of gallbladder and common bile duct by ultrasonography.
abstract: OBJECTIVE
  Bedside emergency ultrasonograAmerican Society of Emergency Radiologyphy is a rapid diagnostic tool in the emergency department (ED). Nevertheless, the learning curve for ultrasound (US) training in various indications has to date not been clearly defined. The aim of the present study was to assess how much a short specialized training program in hepatobiliary US might impact the skills of novice emergency medicine residents.
  
  
  METHODS
  This was a prospective observational study conducted at a university-affiliated ED from May 2014 to January 2015. Adult patients who had right upper quadrant (RUQ) abdominal pain were included. Prior to enrolling patients, seven residents voluntarily passed a 10-h hepatobiliary US training course; they also carried out 20 hands-on US examinations. To compare the results, three board-certified radiologists performed another US examination blindly. The degree of agreement between the two groups was calculated.
  
  
  RESULTS
  A total of 200 individuals enrolled, among whom 106 (53%) were males and 53 (47%) were females. Mean ± SD age was 50.21 ± 22.06 years. There was a moderate to perfect level of agreement between emergency medicine residents and radiologists in terms of the presence of a gallstone (Cohen's kappa = 0.85), sonographic Murphy sign (Cohen's kappa = 0.95), gallbladder wall thickening (Cohen kappa = 0.75), and common bile duct (CBD) dilation (Cohen's kappa = 0.79).
  
  
  CONCLUSIONS
  Novice emergency medicine residents attained a moderate to perfect degree of agreement with expert radiologists in detecting gallstone presence, thick gallbladder wall, sonographic Murphy sign, and CBD dilation in standard patients, after participating in a specific US course.
authors.affiliation: Department of Emergency Medicine, Tehran University of Medical Sciences, Dr Shariati Hospital, Kargar Ave, Tehran, Iran.
authors.forename: Javad
authors.initials: J
authors.lastname: Seyedhosseini
authors.affiliation: Department of Emergency Medicine, Tehran University of Medical Sciences, Dr Shariati Hospital, Kargar Ave, Tehran, Iran.
authors.forename: Azade
authors.initials: A
authors.lastname: Nasrelari
authors.affiliation: Department of Emergency Medicine, Tehran University of Medical Sciences, Dr Shariati Hospital, Kargar Ave, Tehran, Iran.
authors.forename: Narges
authors.initials: N
authors.lastname: Mohammadrezaei
authors.affiliation: Department of Emergency Medicine, Tehran University of Medical Sciences, Dr Shariati Hospital, Kargar Ave, Tehran, Iran. e-karimi@sina.tums.ac.ir.
authors.forename: Ehsan
authors.initials: E
authors.lastname: Karimialavijeh
mesh_terms: D002983:Clinical Competence; D003135:Common Bile Duct / Q000000981:diagnostic imaging*; D004635:Emergency Medicine / Q000193:education*; D004636:Emergency Service, Hospital; D005260:Female; D005705:Gallbladder Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D000072177:Radiologists; D015203:Reproducibility of Results; D014463:Ultrasonography / Q000379:methods*
keywords: Common bile duct; Emergency medicine; Gallbladder; Ultrasound