Surgical Residents and Ultrasound Technician Accuracy and Cost-effectiveness of Ultrasound in Trauma

Abstract

The purpose of this study is 2-fold: 1) to assess the accuracy of the Focused Abdominal Sonogram for Trauma (FAST) as an important evaluative tool for the trauma victim as compared with other objective testing resources (i.e., computerized axial tomography scan); and 2) to analyze the cost-effectiveness of FAST as performed by surgical residents as compared with ultrasound (US) technicians. FAST was performed on 650 trauma victims over a period of 12 months. Testing was completed in a trauma room of the emergency department by an US technician or a trauma surgical resident as determined by the availability of the US technician. Hypotensive patients required two FASTs to be completed for comparison of results. Persistent difficulty interpreting the FAST required the addition of a computerized axial tomography scan to help clarify the results. Statistical analysis was performed using χ² and analysis of variance. False positive, false negative, and true positive, true negative, along with the accuracy of FAST were calculated as compared with other diagnostic testing. The finding indicated that FAST was both specific (99 per cent) and sensitive (68 per cent) in the sample used. Of the 650 patients receiving FAST, true negative was 95 per cent, true positive was 3 per cent as compared with false negative at 1 per cent, and false positive at 0.5 per cent. US technicians performed 81 per cent of the FASTs with an accuracy of 92 per cent. In comparison, surgical residents had a 92 per cent rate of accuracy in the remaining 19 per cent of the population. The mean accuracy of both was 94 per cent. Furthermore, FAST as performed by resident incurred a single fee of $88 for radiological readings as compared with $274 for an US technician fee plus the radiological reading fee of $88. FAST as performed by surgical residents is more cost-effective than FAST as performed by an US technician.

Get full access to this article

View all access options for this article.

References

McKenney

, Martin

, Lentz

, . 1,000 consecutive ultrasounds for blunt abdominal trauma. J Trauma 1996;40:607–10.

Rozycky

, Ochsner

, Schmidt

, . A prospective study of surgeon performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma 1995;39:492–500.

Ali

, Rozycky

, Campbell

, . Trauma ultrasound workshop improves physician detection of peritoneal and pericardial fluid. J Surg Res 1996;63:275–9.

Thomas

, Falcone

, Vasquez

, . Ultrasound evaluation of blunt abdominal trauma: Program implementation, initial experience and learning curve. J Trauma 1997;42:384–90.

Frezza

, Lopez

, Ferone

, Spence

, Martin

A cadaver laboratory to improve the surgical resident technique and accuracy of the trauma ultrasound.

Am Surg 1999 (In press).

Ingeman

, Plewa

, Okasinski

, . Emergency physician use of ultrasound in blunt abdominal trauma. Ann Emerg Med 1996;3:931–7.

Brunader

Accuracy of prenatal sonography performed by family practice residents.

Fam Med 1996;28:407–10.

Wojak

, Cayton

, Nolan

TE.

Outcomes of ultrasound diagnoses of ectopic pregnancy. Dependence on observer experience.

Investig Radiol 1995;30:115–7.