A preliminary evaluation of emergency ultrasound in the setting of an emergency medicine training program

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.