Effect of Provider Experience on Clinician-Performed Ultrasonography for Hydronephrosis in Patients With Suspected Renal Colic

Abstract

Overall, ultrasonography performed by emergency clinicians was moderately sensitive and specific for detection of hydronephrosis as seen on CT in patients with suspected renal colic. However, presence or absence of hydronephrosis as determined by emergency physicians with fellowship training in ultrasonography yielded more definitive test results. For clinicians without fellowship training, there was no significant difference between groups in the predictive accuracy of the application according to experience level.

STONE PLUS: Evaluation of Emergency Department Patients With Suspected Renal Colic, Using a Clinical Prediction Tool Combined With Point-of-Care Limited Ultrasonography

“…A previous publication details the performance characteristics of PLUS by practitioners of different levels at our institution, many of whom participated in this study. 10 Our institution has an active point-ofcare ultrasonography program, including an emergency ultrasonography fellowship, as well as training requirements for residents that meet or exceed American College of Emergency Physician guidelines. 14 …”

“…Previous work from our group has shown that emergency physicians with fellowship training in ultrasonography are better at accurately discerning hydronephrosis, and addition of PLUS by this group may provide more benefit than addition of ultrasonography by nonfellowship-trained emergency physicians. 10 Although all of the patients in our study received both ultrasonography and a CT scan, patients were eligible for inclusion only if the provider intended to order CT for suspected renal colic. Thus, some patients with symptomatic stones may not have been included if they were discharged without CT imaging.…”

“…8,9 Hydronephrosis, an indirect sign of an obstructing stone, can be identified by providers with various levels of training and may correlate with stone size. 10,11 Importance A clinical prediction score for symptomatic ureteral stone may be able to reduce unnecessary imaging in patients with flank pain by identifying those with high likelihood of CT-diagnosed, uncomplicated, symptomatic stone and a low risk of acutely important alternative findings. We previously derived and validated a clinical prediction tool, the Sex, Timing, Origin, Nausea, Erythrocytes (STONE) score, which reliably risk stratifies patients, using 5 clinically available risk factors (Table 1).…”

Research Priorities for the Influence of Gender on Diagnostic Imaging Choices in the Emergency Department Setting

“…51,52 Point-of-care US represents an increasingly available imaging modality that may be used to reduce unnecessary CT scanning, although it is a user-dependent technology. 53,54 A recently published clinical prediction rule for ureteral stone, the "STONE score," incorporates sex and may be an effective way to predict ureteral stone without imaging, or to select patients who are more appropriate for reduced dose CT. 55 Research Question.…”

The Transfer of Problem-Based Learning Skills to Clinical Practice

“…Educational programs that develop competence to practice are essential in sonography. Sonography is considered a user-dependent imaging modality because the quality of its examinations is heavily dependent on the expertise of the sonographer (Herbst et al, 2014;Trout, Sanchez, LadinoTorres, Pai, & Strouse, 2012). A master's program was selected for sonography education in Ireland due to this recognition of the high level of knowledge required to practice competently in this complex and rapidly evolving field.…”