R. Lanoix et al., A preliminary evaluation of emergency ultrasound in the setting of an emergency medicine training program, AM J EMER M, 18(1), 2000, pp. 41-45
In this article we seek to evaluate the diagnostic accuracy of emergency ph
ysicians performing emergency ultrasonography in the setting of an emergenc
y medicine training program. A prospective observational study was performe
d at an inner city Level I trauma center with an emergency medicine residen
cy training program. From July 1994 to December 1996 a convenience sample o
f ultrasound exams was recorded. The diagnostic quality ("acceptable or tec
hnically limited") was determined by a board-certified cardiologist or radi
ologist with fellowship training in ultrasonography, The emergency departme
nt interpretations were then compared to those of the blinded cardiologist
or radiologist. Four hundred and fifty-six ultrasound examinations were vid
eotaped and entered into the study; 408 (89%) of the studies performed were
determined to be "acceptable." The diagnostic accuracy (sensitivity, speci
ficity, positive and negative predictive values) of these studies were as f
ollows: cardiac, to rule out effusion (n = 67; 0.83, 0.98, 0.88, 0.98); tra
nsabdominal, to rule out abdominal aortic aneurysms (AAA), cholelithiasis,
or free peritoneal fluid (n = 263; 0.91, 0.89, 0.88, 0.92); renal, to rule
out hydronephrosis (n = 45; 0.94, 0.96, 0.94, 0.96); pelvic, to rule in int
rauterine pregnancy (n = 33; 1.0, 0.90, 0.96, 1.0), The 48 "technically lim
ited studies" included: 39 transabdominal (33 gallbladder, 1 abdominal aort
ic aneurysm, 5 free peritoneal fluid), 6 cardiac, 2 renal, and 1 pelvic ult
rasound. This study suggests that emergency physicians with a minimal amoun
t of training display acceptable technical skill and interpretive acumen in
their approach to emergency ultrasonography. Copyright (C) 2000 by W.B. Sa
unders Company.