Original contributionGoal-directed abdominal ultrasonography: impact on real-time decision making in the Emergency Department
Introduction
An essential component in the success of ultrasonography (US) in the Emergency Department (ED) has been its portability and easy integration into the clinical process. The term “goal-directed” ultrasonography describes the manner in which images are obtained at the bedside and then incorporated real-time into an overall clinical assessment of the patient. This has led some to describe US as the stethoscope of the new millennium; a more clinical tool than pure imaging modality. With most studies focusing on either feasibility or diagnostic accuracy, it remains unclear to what extent ED US may influence key clinical elements of the decision-making process such as diagnostic certainty, treatment, and disposition 1, 2, 3, 4, 5, 6, 7. The ultimate value of any diagnostic test must be judged in part by its impact on physician behavior and management decisions. Information on the accuracy and sensitivity of ED ultrasound, described in previous studies, offers little insight into how emergency physicians incorporate their own bedside images into overall patient care 1, 2, 3, 4, 5, 6, 7.
We sought to evaluate the impact of “goal-directed” abdominal ultrasonography on real-time decision making in the ED with specific emphasis on physicians’ certainty of diagnosis, treatment, and disposition.
Section snippets
Materials and methods
Ultrasonography was performed and interpreted by one of five credentialed sonographers using an Aloka 650 CL or Medison SA-6000 ultrasound machine. The Department of Emergency Medicine, together with the hospital’s credentialing committee, implemented credentialing guidelines for the use of ultrasound in the ED. These guidelines were modeled on those proposed by Mateer et al. in the 1994 SAEM guidelines and include a 16-h didactic course, 17 training examinations, and 155 practice examinations
Results
A total of 212 patients were enrolled in our study. Twelve patients (6%) were excluded from the data analysis due to incomplete forms. The median number of examinations performed by the five study physicians was 32 (range 20–65). Table 1 lists the distribution and percentages of presenting chief complaints and corresponding suspected disease processes of the remaining 200 patients. The two most common indications for ED US were the evaluation of biliary tract disease (38%) and complications of
Discussion
The results of this study suggest that among experienced ED sonographers at our institution, goal-directed abdominal US significantly impacts diagnostic, treatment, and disposition certainty. This impact seems to be greater for diagnostic certainty than for either treatment or disposition decisions.
In patients with either a high or low pretest probability of disease, a confirmatory test usually allows the physician to either rule in or rule out the disease process. In this study, 92 patients
References (8)
- et al.
Patient satisfaction and diagnostic accuracy with ultrasound by emergency physicians
Am J Emerg Med
(1999) - et al.
Pelvic ultrasound performed by emergency physicians for the detection of ectopic pregnancy in complicated first-trimester pregnancies
Ann Emerg Med
(1997) - et al.
A prospective study of ultrasonography in the ED by emergency physicians
Am J Emerg Med
(1994) - et al.
Emergency department sonography by emergency physicians
Am J Emerg Med
(1989)
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