Abstract. Objectives: Bedside ultrasound examination by emergency physicians (EPs) is being integrated into clinical emergency practice, yet minimum training requirements have not been well defined or evaluated. This study evaluated the accuracy of EP ultrasonography following a 16-hour introductory ultrasound course. Methods: In phase I of the study, a condensed 16-hour emergency ultrasound curriculum based on Society for Academic Emergency Medicine guidelines was administered to emergency medicine houseofficers, attending staff, medical students, and physician assistants over two days. Lectures with syllabus material were used to cover the following ultrasound topics in eight hours: basic physics, pelvis, right upper quadrant, renal, aorta, trauma, and echocardiography. In addition, each student received eight hours of hands-on ultrasound instruction over the two-day period. All participants in this curriculum received a standardized pretest and posttest that included 24 emergency ultrasound images for interpretation. These images included positive, negative, and nondiagnostic scans in each of the above clinical categories. In phase II of the study, ultrasound examinations performed by postgraduate-year-2 (PGY2) houseofficers over a ten-month period were examined and the standardized test was readministered. Results: In phase I, a total of 80 health professionals underwent standardized training and testing. The mean Ϯ SD pretest score was 15.6 Ϯ 4.2, 95% CI = 14.7 to 16.5 (65% of a maximum score of 24), and the mean Ϯ SD posttest score was 20.2 Ϯ 1.6, 95% CI = 19.8 to 20.6 (84%) (p < 0.05). In phase II, a total of 1,138 examinations were performed by 18 PGY2 houseofficers. Sensitivity was 92.4% (95% CI = 89% to 95%), specificity was 96.1% (95% CI = 94% to 98%), and overall accuracy was 94.6% (95% CI = 93% to 96%). The follow-up ultrasound written test showed continued good performance (20.7 Ϯ 1.2, 95% CI = 20.0 to 21.4). Conclusions: Emergency physicians can be taught focused ultrasonography with a high degree of accuracy, and a 16-hour course serves as a good introductory foundation.

Abstract. Objective: To determine the role of bedside renal ultrasonography (US) and plain radiography of the kidneys, ureters, and bladder (KUB) as the initial investigative modality for those patients presenting to the ED with unilateral flank pain and hematuria. The hypothesis was that the renal US + KUB may obviate the need for emergent IV pyelography (IVP) in a majority of patients. Methods: Prospective study over an 8-month period of all consecutive adult patients between the ages of 18 and 65 years presenting with unilateral flank pain and hematuria to the ED a t LAC + USC Medical Center.Patients received KUB followed by a 500-mL bolus of normal saline. Bedside US was then performed by emergency physicians (EPs). Hydronephrosis of the kidney was graded as mild, moderate, or severe. All patients then underwent IVP. The results of the bedside US + KUB were then compared with those of IVP (the criterion standard). Results: Of a total of 139 eligible patients, 108 were enrolled. The combination of US and KUB correctly identified pathology consistent with nephroureterolithiasis with a sensitivity of 97.1% (95% CI = 93.1-100%) when compared with IVP. The KUB + US results were falsely positive in 16 patients, resulting in a specificity of 58.9% (95% CI = 43.5-74.370). The positive predictive value of the combined modality was 80.7%, the negative predictive value was 92.0%, and the overall accuracy was 83.3%. Conclusion: The bedside US + KUB has a high sensitivity and can be performed rapidly a t the bedside by the EP when compared with IVP. This combined modality is a n effective screening tool in the initial evaluation of ureteral colic. Key words: renal colic; renal ultrasound; nephroureterolithiasis; ureteral colic; KUB; radiography. ACADEMIC EMERGENCY MEDICINE 1998; 5:666-671 MERGENT IV pyelography (IVP) has tradi-E tionally been the recommended modality for evaluating patients with acute unilateral flank pain and hematuria. IVP has a number of limitations and is not recommended in patients with renal insufficiency, those with a history of past allergic reactions to contrast material, or patients who are pregnant. Performing IVP is time-consuming, causing an increased length of stay in the ED, and involves other personnel, some of whom may not be immediately available (radiologist, technician). Despite these issues, IVP continues to be described as the criterion standard in the initial evaluation of ureteral colic.' Ultrasonography (US) is a noninvasive, safe, and reliable imaging modality that can be performed at the bedside. While the use of US by the emergency physician (EP) has recently been advocated in the assessment of a wide variety of clinical little has been reported regarding the use of this modality in the assessment of nephroureterolithiasis. Multiple reports in the urologic and radiologic literature indicate that US is a safe and noninvasive method of screening for renal ~b s t r u c t i o n .~-~~ Its bedside use by EPs makes it an inexpensive and rapid alternative to IVP.We undertook a pros...