BACKGROUND: Emergency department bedside ultrasonography (EUS) can expedite treatment for patients. However, it is unknown how much experience is required for competency in the sonographic diagnosis of cholelithiasis and cholecystitis. OBJECTIVES: The objective was to assess the learning curve of physicians training in right upper quadrant (RUQ) EUS. METHODS: This was a prospective study at an urban, academic emergency department from August 1999 to July 2006. Patients with suspected biliary tract disease underwent RUQ EUS followed by abdominal ultra sonography (AUS) by the Department of Radiology. Results of EUS were compared to AUS using a predesigned, standardized data sheet. RESULTS: A total of 1,837 patients underwent EUS by 127 physicians. The overall sensitivity and specificity of EUS for cholelithiasis were 84% (95% confidence interval [CI] = 81% to 86%) and 86% (95% CI = 83% to 88%), respectively. The overall sensitivity of EUS for ductal dilation, gallbladder wall thickening, pericholecystic fluid, and sludge were each < 60%. When analyzing the EUS test characteristics, for every increase in 10 examinations up to 50 examinations, there was no significant improvement in the sensitivity or specificity for any of these sonographic findings. Moreover, on probit regression analysis, accounting for clustering or correlation among the examinations performed by each of the operators, there was no improvement for detecting any of the sonographic findings except for pericholecystic fluid for every 10 additional examinations performed. CONCLUSIONS: When adjusting for operator dependence, performing up to 50 EUS examinations appears to have little effect on the accuracy of RUQ EUS. Rather than simply requiring an arbitrary number of examinations, another method of competency assessment may be necessary.
BACKGROUND: Emergency department bedside ultrasonography (EUS) can expedite treatment for patients. However, it is unknown how much experience is required for competency in the sonographic diagnosis of cholelithiasis and cholecystitis. OBJECTIVES: The objective was to assess the learning curve of physicians training in right upper quadrant (RUQ) EUS. METHODS: This was a prospective study at an urban, academic emergency department from August 1999 to July 2006. Patients with suspected biliary tract disease underwent RUQ EUS followed by abdominal ultra sonography (AUS) by the Department of Radiology. Results of EUS were compared to AUS using a predesigned, standardized data sheet. RESULTS: A total of 1,837 patients underwent EUS by 127 physicians. The overall sensitivity and specificity of EUS for cholelithiasis were 84% (95% confidence interval [CI] = 81% to 86%) and 86% (95% CI = 83% to 88%), respectively. The overall sensitivity of EUS for ductal dilation, gallbladder wall thickening, pericholecystic fluid, and sludge were each < 60%. When analyzing the EUS test characteristics, for every increase in 10 examinations up to 50 examinations, there was no significant improvement in the sensitivity or specificity for any of these sonographic findings. Moreover, on probit regression analysis, accounting for clustering or correlation among the examinations performed by each of the operators, there was no improvement for detecting any of the sonographic findings except for pericholecystic fluid for every 10 additional examinations performed. CONCLUSIONS: When adjusting for operator dependence, performing up to 50 EUS examinations appears to have little effect on the accuracy of RUQ EUS. Rather than simply requiring an arbitrary number of examinations, another method of competency assessment may be necessary.
Authors: Jennifer R Marin; Alyssa M Abo; Alexander C Arroyo; Stephanie J Doniger; Jason W Fischer; Rachel Rempell; Brandi Gary; James F Holmes; David O Kessler; Samuel H F Lam; Marla C Levine; Jason A Levy; Alice Murray; Lorraine Ng; Vicki E Noble; Daniela Ramirez-Schrempp; David C Riley; Turandot Saul; Vaishali Shah; Adam B Sivitz; Ee Tein Tay; David Teng; Lindsey Chaudoin; James W Tsung; Rebecca L Vieira; Yaffa M Vitberg; Resa E Lewiss Journal: Crit Ultrasound J Date: 2016-11-03
Authors: Marta Del Medico; Alessandra Altieri; Gabriella Carnevale-Maffè; Pietro Formagnana; Francesco Casella; Marco Barchiesi; Manuela Bergonzi; Claudia Vattiato; Giovanni Casazza; Chiara Cogliati Journal: Intern Emerg Med Date: 2018-07-07 Impact factor: 3.397
Authors: Delia Gold; Marla Levine; Deborah Hsu; David P Way; Allan E Shefrin; Samuel H F Lam; Resa Lewiss; Jennifer R Marin Journal: AEM Educ Train Date: 2021-08-01
Authors: M G Tolsgaard; C Ringsted; E Dreisler; L N Nørgaard; J H Petersen; M E Madsen; N L C Freiesleben; J L Sørensen; A Tabor Journal: Ultrasound Obstet Gynecol Date: 2015-08-06 Impact factor: 7.299
Authors: Charlotte Loumann Krogh; Jacob Steinmetz; Søren Steemann Rudolph; Rasmus Hesselfeldt; Freddy K Lippert; Peter A Berlac; Lars S Rasmussen Journal: Scand J Trauma Resusc Emerg Med Date: 2016-08-04 Impact factor: 2.953
Authors: Martin G Tolsgaard; Tobias Todsen; Jette L Sorensen; Charlotte Ringsted; Torben Lorentzen; Bent Ottesen; Ann Tabor Journal: PLoS One Date: 2013-02-28 Impact factor: 3.240