From the June 2011 issue of HealthCare Business News magazine
However, a February New England Journal of Medicine review offers a key insight: Non-radiologists are not encroaching on the traditional domain of radiologists. Instead, the concept of a limited, or focused, examination plays an important role in use of ultrasound at the point of care, the researchers from the Departments of Emergency Medicine and Obstetrics, Gynecology, and Reproductive Sciences at Yale reported. “Clinicians from diverse specialties can become very adept at using ultrasonography to examine a particular organ, disease or procedure that is relevant to there area of expertise, whereas imaging specialists typically perform a more comprehensive examination.”
Ultrasound accuracy
The FAST (Focused Assessment with Sonography for Trauma) examination is a perfect example of this important distinction. This use of ultrasound at the point of care enables emergency medicine physicians a safer way to assess trauma patients for potentially life-threatening problems, by checking for fluid, including hemorrhaging, with a sensitivity of 73 to 99 percent, according to the NEJM review. The overall accuracy for clinically significant intraabdominal injury in trauma patients is 90 to 98 percent. What’s more, the FAST exam has been shown to decrease the need for CT and to speed up treatment, thus resulting in shorter hospital stays, lower costs, and reduced mortality.
A study presented at American College of Emergency Physicians Research Forum last year also found that ultrasound at the point of care was 85 percent accurate for evaluating acute appendicitis in children, one of the most common abdominal surgical emergencies in children, with about 80,000 such cases in the United States each year. Ultrasound is the preferred modality for this age group, due to mounting public health concerns over the risks of radiation exposure.
Emergency physicians and the other principal physician specialties that use ultrasound in their practices are trained in residency and fellowship and have clinical experience in integrating their findings into the patient’s entire treatment plan. In addition, the American College of Emergency Medicine (ACEP) updated its evidence-based emergency ultrasound guidelines in 2009, reporting that the technology is widely used at bedside to diagnose acute, life-threatening disorders, guide invasive procedures and aid emergency medicine physicians in developing a treatment plan. Not only does the ACEP deem the ability to perform and interpret emergency ultrasound to be a fundamental skill for emergency physicians, but it also endorses having dedicated ultrasound equipment at bedsides in the ED.
