Emergency medicine residents' learning curve in diagnosing deep vein thrombosis with 3-point venous point-of-care ultrasound

被引:0
作者
Kang, Soo Yeon [1 ,2 ]
Jo, Ik Joon [3 ]
Heo, Sejin [3 ]
Chang, Hansol [3 ]
Lee, Guntak [3 ]
Park, Jong Eun [3 ]
Kim, Taerim [3 ]
Lee, Se Uk [3 ]
Kim, Min Ji [4 ]
Yoon, Hee [3 ]
机构
[1] Chung Ang Univ, Sch Med, Dept Emergency Med, Gwangmyeong Hosp, Gwangmyeong 14353, Gyeonggi Do, South Korea
[2] Kangwon Natl Univ, Coll Med, Dept Emergency Med, Chunchon 24341, Gangwon Do, South Korea
[3] Sungkyunkwan Univ, Samsung Med Ctr, Dept Emergency Med, Sch Med, 115 Irwon-ro, Seoul 06351, South Korea
[4] Res Inst Future Med, Biomed Stat Ctr, Samsung Med Ctr, Seoul 06351, South Korea
关键词
Emergency medicine; Deep vein thrombosis; Point-of-care ultrasound; Learning curve; Diagnostic accuracy; LOWER-EXTREMITY; PULMONARY-EMBOLISM; COMPRESSION ULTRASOUND; AMERICAN-COLLEGE; D-DIMER; PHYSICIANS; ULTRASONOGRAPHY; DOPPLER; TIME; THROMBOEMBOLISM;
D O I
10.1186/s12245-024-00645-x
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background Many cases of deep vein thrombosis (DVT) are diagnosed in the emergency department, and abbreviated lower extremity venous point-of-care ultrasound (POCUS) has already shown an accuracy comparable to that of specialists. This study aimed to identify the learning curve necessary for emergency medicine (EM) residents to achieve expertise-level accuracy in diagnosing DVT through a 3-point lower extremity venous POCUS.Methods This prospective study was conducted at an emergency department between May 2021 and October 2022. Four EM residents underwent a one-hour POCUS training session and performed DVT assessments in participants with DVT symptoms or confirmed pulmonary embolism. POCUS was performed at three proximal lower extremity sites to evaluate the thrombi presence and vein compressibility, with results validated by specialized radiology ultrasound. Cumulative sum (CUSUM) and the Bush and Mosteller models were used to analyze the learning curve, while generalized estimating equations were used to identify factors affecting diagnostic accuracy.Results 91 POCUS scans were conducted in 49 patients, resulting in 22% DVT confirmed by specialized venous ultrasound. In the CUSUM analysis, all four EM residents attained a 90% success rate at the common femoral vein, whereas only half achieved this rate when all three sites were considered. According to Bush and Mosteller models, 13-18 cases are required to attain 90-95% diagnostic accuracy. After 10-16 cases, the examination time for each resident decreased, and a 20% increase in examiner confidence was linked to a 2.506-fold increase in the DVT diagnosis accuracy.Conclusion EM residents generally required 13-18 cases for 90-95% DVT diagnostic accuracy, but proficiency varied among individuals, particularly requiring more cases for regions outside the common femoral vein.
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页数:9
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