Ultrasound evaluation of blunt abdominal trauma: Program implementation, initial experience, and learning curve

Objective: Although sonographic screening for blunt abdominal trauma is gaining acceptance, standards for implementation, training, credentialing, and quality control remain to be established. Design: This prospective study examines a Level I trauma service experience with the de novo establishment of a trauma ultrasound (US) program credentialed through the Department of Surgery under the auspices of Continuous Quality Improvement. Materials and Methods: All trauma surgeons attended a combined didactic and ''hands on'' 8-hour trauma US course, Abdominal sonography was subsequently performed on patients with potential blunt abdominal trauma followed by a standard diagnostic evaluation, which included computed tomographic scan, diagnostic peritoneal lavage, or observation. Measurements and Main Results: Three hundred patients were studied over a 4-month period, They averaged 35 years of age with an average injury severity score of 12, The time required to perform the US examination averaged less than 3 minutes, Standard diagnostic evaluation included computed tomographic scan (21%), diagnostic peritoneal lavage (45%), and observation (34%), US examinations resulted in 277 true negatives, 17 true positives, two false positives, and four false negatives for a sensitivity of 81.0%, a specificity of 99.3%, and an accuracy of 98.0%, Annualized cost savings with the use of US evaluation versus standard diagnostic evaluation would amount to over $100,000.00. Conclusions: This experience with the de novo implementation of a trauma US program suggests that the training and credentialing requirements in this study are sufficient to provide surgeon ultrasonographers with acceptable competence in US diagnosis of blunt abdominal trauma.