Accuracy of emergency department bedside ultrasonography

Authors

  • Jane L Rowland,

    1. Departments of Emergency Medicine and
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    • Jane L Rowland, MB  BS, Emergency Medicine Registrar (current position, Emergency Medicine Consultant, Lyell Mcewin Health Service);

  • Marie Kuhn,

    Corresponding author
    1. Departments of Emergency Medicine and
      Correspondence: Dr Marie Kuhn, Emergency Department, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Email:mkuhn@mail.rah.sa.gov.au
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    • Marie Kuhn, MD, FACEM, FACEP, Emergency Department Director;

  • Robert LL Bonnin,

    1. Departments of Emergency Medicine and
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    • Robert LL Bonnin, MB  BS, FACEM, Emergency Medicine Consultant;

  • Michael J Davey,

    1. Departments of Emergency Medicine and
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    • Michael J Davey, MB  BS, FACEM, Emergency Medicine Consultant;

  • Suzanne LeP Langlois

    1. Radiology, The Royal Adelaide Hospital, Adelaide, South Australia, Australia
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    • Suzanne LeP Langlois, MB  BS, FRACR, DDU, Radiology Department Director.


Correspondence: Dr Marie Kuhn, Emergency Department, Royal Adelaide Hospital, North Terrace, Adelaide, SA 5000, Australia. Email:mkuhn@mail.rah.sa.gov.au

Abstract

Abstract

Objectives:

To determine which focused ultrasound examinations can be interpreted accurately by emergency physicians who have limited training and experience. To determine whether image quality and/or the operator’s level of confidence in the findings correlates with accurate scan interpretation.

Methods:

A prospective sample of consenting adult emergency department patients with the conditions was selected for study. Scans were performed by emergency physicians who had attended a 3-day focused ultrasound examinations instruction course. All scans were videotaped and subsequently reviewed by a radiologist. Accuracy was determined by comparing the emergency physicians scan interpretation with preselected gold standards. Chi-squared tests were employed to determine if the individual performing the scan, the type of scan, patient’s body habitus, image quality and/or operator confidence were reliable predictors of accuracy.

Results:

Between September 1997 and January 1999, 221  scans were studied. Accuracy varied widely depending on the type of scan performed: aortic scans were 100% accurate whereas renal scans had 68% accuracy. On bivariate analyses, there was little variation in the various operators’ levels of proficiency and accuracy of interpretation was not associated with patient body habitus, image quality or operator confidence.

Conclusions:

Neophytes can accurately perform and interpret aortic scans; additional training and/or experience appear to be necessary to achieve proficiency in conducting most of the other scans studied. Inexperienced operators are unable to discern whether their scan interpretations will prove accurate.

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