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Emergency Physician Interpretation of Point‐of‐care Ultrasound for Identifying and Grading of Hydronephrosis in Renal Colic Compared With Consensus Interpretation by Emergency Radiologists
Author(s) -
Pathan Sameer A.,
Mitra Biswadev,
Mirza Salman,
Momin Umais,
Ahmed Zahoor,
Andraous Lubna G.,
Shukla Dharmesh,
Shariff Mohammed Y.,
Makki Magid M.,
George Tinsy T.,
Khan Saad S.,
Thomas Stephen H.,
Cameron Peter A.
Publication year - 2018
Publication title -
academic emergency medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.221
H-Index - 124
eISSN - 1553-2712
pISSN - 1069-6563
DOI - 10.1111/acem.13432
Subject(s) - medicine , emergency ultrasound , hydronephrosis , emergency department , radiology , grading (engineering) , ultrasound , confidence interval , point of care ultrasound , renal colic , focused assessment with sonography for trauma , nuclear medicine , pathology , urinary system , alternative medicine , nursing , abdominal trauma , civil engineering , engineering , blunt
Objective The ability of emergency physicians ( EP s) to identify hydronephrosis using point‐of‐care ultrasound ( POCUS ) has been assessed in the past using computed tomography ( CT ) scans as the reference standard. We aimed to determine the ability of EP s to identify and grade hydronephrosis on POCUS using the consensus interpretation of POCUS by emergency radiologists as the reference standard. Methods The study was conducted at an urban academic emergency department ( ED ) as a secondary analysis of previously collected ultrasound data from the EP ‐performed POCUS databank. Patients were eligible for inclusion if they had both POCUS and CT scanning performed during the index ED visit. Two board‐certified emergency radiologists and six EP s interpreted each POCUS study independently. The interpretations were compared with the consensus interpretation by emergency radiologists. Additionally, the POCUS interpretations were also compared with the corresponding CT findings. Institutional approval was obtained for conducting this study. All the analyses were performed using Stata MP 14.0 (StataCorp). Results A total of 651 patient image‐data sets were eligible for inclusion in this study. Hydronephrosis was reported in 69.6% of POCUS examinations by radiologists and 72.7% of CT scans (p = 0.22). Using the consensus radiology interpretation of POCUS as the reference standard, EP s had an overall sensitivity of 85.7% (95% confidence interval [ CI ] = 84.3%–87.0%), specificity of 65.9% (95% CI = 63.1%–68.7%), positive likelihood ratio of 2.5 (95% CI = 2.3–2.7), and negative likelihood ratio of 0.22 (95% CI = 0.19–0.24) for hydronephrosis. When using CT scan as the reference standard, the EP s had an overall sensitivity of 81.1% (95% CI = 79.6% to 82.5%), specificity of 59.4% (95% CI = 56.4%–62.5%), positive likelihood ratio of 2.0 (95% CI = 1.8–2.2), and negative likelihood ratio of 0.32 (95% CI = 0.29–0.35) for hydronephrosis. The specificity of EP s was improved to 94.6% (95% CI = 93.7%–95.4%) for categorizing the degree of hydronephrosis as “moderate or severe” versus “none or mild,” with positive likelihood ratio of 6.33 (95% CI = 5.3–7.5) and negative likelihood ratio of 0.69 (95% CI = 0.66–0.73). Conclusions Emergency physicians were found to have moderate to high sensitivity for identifying hydronephrosis on POCUS when compared with the consensus interpretation of the same studies by emergency radiologists. These POCUS findings by EP s produced more definitive results when at least moderate degree of hydronephrosis was present.