INSTITUTIONAL LEARNING-CURVE OF SURGEON-PERFORMED TRAUMA ULTRASOUND

Background: Sonography has become the primary mode for the initial eva luation of abdominal injury in many trauma centers. However, the rate at which nonradiologists become proficient in this technique remains c ontroversial. Objective: To assess the learning curve for this techniq ue in a single institution. Design: Retrospective review of sonographi c examinations for trauma performed by senior surgical residents durin g a 24-month period at an American College of Surgeons-verified level I trauma center. Setting: University-affiliated private hospital. Pati ents and Methods: Before the initiation of a program of surgeon-perfor med trauma ultrasound, senior surgical-residents (postgraduate years 4 and 5) received 11.5 hours of hands-on and didactic instruction in th e focused ultrasound examination for trauma. This examination then bec ame a standard component of the evaluation of injured patients. Subseq uent groups of senior residents received 8 hours of instruction at the onset of new academic years, 6 and 18 months, respectively, after the initial course. The sensitivity, specificity, accuracy, positive pred ictive value, and negative predictive value were then calculated for e ach 6-month period after the introduction of trauma sonography. Result s: During the 24-month study period, 902 sonographic examinations were performed. No statistically significant differences were noted in sen sitivity, specificity, accuracy, positive predictive value, or negativ e predictive value for any 6-month period of study when compared with the other 6-month periods or with the values calculated for the entire study period. Conclusions: Senior surgical residents are capable of p erforming the focused ultrasound examination for trauma with a high le vel of skill after a concise introductory course. A learning curve was not apparent in our series. Criteria for being permitted to perform t rauma sonography that include the requirement of a large number of exa minations or extensive proctoring should be reassessed.