Short- and long-term effects of emergency medicine sonography on formal sonography use: a decade of experience.

OBJECTIVES: It has been reported that use of formal sonographic studies by departments of radiology initially increases after inception of an emergency medicine (EM) sonography training program, but there are no data on whether this trend continues as the training program matures. The purpose of this study was to evaluate the effect of an ongoing EM sonography program on formal sonography use after more than a decade of experience. METHODS: This retrospective, computer-assisted review compared emergency department (ED) abdominal sonographic studies ordered in the 3 years before inception of an EM sonography program (1992-1994) with those ordered in the 8 years after its inception (1995-2002). To determine the relative change, all abdominal sonograms ordered by ED physicians were compared with equivalent outpatient formal sonograms by all other physicians in the hospital. The study site is a community teaching hospital with a current ED census of 50,000. RESULTS: In the initial 4 years (1995-1998), the number of formal studies increased significantly in both absolute numbers (annual mean, 95 versus 162; P < .002) and as a percentage of all outpatient sonograms ordered at the institution (5.1% versus 8.5%; P < .0001). However, in the following 4 years (1999-2002), the absolute number of formal studies remained constant but decreased when adjusted for an increased ED census. Emergency department-ordered formal studies also decreased as a percentage of all sonograms ordered (5.1% versus 4.1%; P = .002). CONCLUSIONS: Emergency department use of formal sonography services increases with the introduction of ED sonography but decreases markedly as the program matures.     

Live Conjoined Twins: A Rare First Trimester Diagnosis during Emergency Department Sonography

Background: The evaluation of vaginal bleeding and pelvic pain in the first trimester of pregnancy is an important component of emergency physician training. The increased use of bedside sonography by emergency physicians in the evaluation of these patients requires knowledge about the normal anatomy, variants, abnormal findings and their appearance on sonography. Objectives: To highlight the importance of a thorough pelvic and abdominal sonographic examination during a routine evaluation in the emergency department (ED). Case Report: We present the case of a patient found to have conjoined twins diagnosed by ED sonography. Conclusion: A discussion of the diagnosis, the findings on bedside sonogram and management options are presented.     

Hepatic Vein Morphology

Objective. The purpose of this study was to evaluate the accuracy of a new sonographic marker for the diagnosis of cirrhosis using hepatic vein wall changes. Methods. A prospective pilot study evaluating 88 patients, 38 with cirrhosis and 50 with no evidence of liver disease, was undertaken. Hard copy sonograms of the hepatic veins were obtained and reviewed in a blinded fashion by 2 radiologists. The hepatic vein morphology was assessed by 3 parameters: hepatic vein wall straightness, uniformity of hepatic vein wall echogenicity, and visualization of a complete 1‐cm hepatic vein segment. The 3 parameters were compared to evaluate sensitivity and specificity for the diagnosis of cirrhosis. Interobserver and intraobserver errors for each parameter were also calculated with κ statistics to assess reproducibility. Results. There was a strong correlation between altered straightness and nonuniformity of hepatic vein wall echogenicity and cirrhosis. The straightness parameter had superior sensitivity of 97% (95% confidence interval [CI], 85%–100%) and specificity of 91% (95% CI, 78%–97%) for diagnosis of cirrhosis. Uniformity of hepatic vein wall echogenicity was the next most useful parameter, with sensitivity of 88% (95% CI, 73%–97%) and specificity of 86% (95% CI, 72%–95%). The continuous 1‐cm segment of the hepatic vein had sensitivity of 68% (95% CI, 49%–83%) and specificity of 91% (95% CI, 78%–97%). Hepatic vein evaluation was found to show both good intraobserver and interobserver error. Conclusions. Hepatic vein morphology on sonography, in particular, changes in the straightness and uniformity of hepatic vein wall echogenicity, is a new sign of cirrhosis, which may increase the overall accuracy of sonographic diagnosis of cirrhosis and which appears to have a moderately high degree of reproducibility.     

Targeted Musculoarticular Sonography in the Detection of Joint Effusions

This article describes an advanced application for an established technology, specifically the use of bedside sonography in the assessment of the acutely painful joint in the emergency department. The sonographic windows for each of the axial synovial joints are outlined, with a brief discussion of commonly encountered pathologic conditions.     

Ultrasound-guided hip arthrocentesis in the ED

In patients presenting with atraumatic joint pain and swelling, diagnosis is typically made by synovial fluid analysis. Management of an acute suspected hip joint arthritis can present a challenge to the emergency physician (EP). Hip joint effusions are somewhat more difficult to identify and aspirate than effusions in other joints that are commonly managed by EPs. Identification and aspiration of a hip joint effusion under ultrasound guidance is a well-established procedure in the fields of orthopedic surgery and interventional radiology. Here, we report 4 cases of ultrasound-guided hip arthrocentesis at the bedside by EPs; relevant technical details of the procedure are reviewed. These cases demonstrate the feasibility of ultrasound-guided hip arthrocentesis in the emergency department (ED) by EPs. With increasing availability of bedside ultrasound in the ED, suspected hip joint arthritis or infection may be evaluated and managed by the trained EP in a fashion similar to other joint arthritides.     

Cystic Thyroid Nodules After Aspiration Mimicking Malignancy

Objective. The purpose of our study was to provide sonographic findings of cystic nodules, which can mimic malignancies, after fine‐needle aspiration (FNA) and to determine the differential points from malignancies. Methods. We retrospectively reviewed the sonographic findings of 33 lesions in 32 patients who had FNA for predominantly cystic nodules or cysts and showed suspicious findings during sonographic follow‐up, as well as findings of 47 surgically confirmed papillary thyroid carcinomas (PTCs) in 45 consecutive patients. We evaluated the size, shape, presence of shadowing and a halo, margin, echogenicity, and presence of echogenic dots for each nodule. The final diagnosis of cystic nodules was confirmed by FNA, surgery, or follow‐up sonography. Results. Of the 33 cystic lesions, 31 (94%) were adequate with benign results, and 2 (6%) were inadequate specimens at the initial FNA. There were no malignancies in the cystic nodules at follow‐up. The average interval between the initial FNA and suspicious sonographic findings was 26 months (range, 1–92 months). The average size of the suspicious nodules was 0.8 cm (range, 0.3–1.8 cm). Cystic nodules after aspiration were similar to PTCs in their sonographic findings, but the former frequently showed shadowing and a halo (85% versus 21%; P < .0001). With further follow‐up, 29 lesions (88%) showed additional decreases in size. Conclusions. Benign cystic nodules after aspiration can have suspicious malignant features. However, shadowing and a halo associated with malignant features are characteristic findings of cystic nodule shrinkage. Awareness of these findings and correlation with the FNA history can aid in preventing unnecessary FNA.     

Prenatal Diagnosis of Placenta Accreta

Objective. The purpose of this study was to compare the accuracy of transabdominal sonography and magnetic resonance imaging (MRI) for prenatal diagnosis of placenta accreta. Methods. A historical cohort study was undertaken at 3 institutions identifying women at risk for placenta accreta who had undergone both sonography and MRI prenatally. Sonographic and MRI findings were compared with the final diagnosis as determined at delivery and by pathologic examination. Results. Thirty‐two patients who had both sonography and MRI prenatally to evaluate for placenta accreta were identified. Of these, 15 had confirmation of placenta accreta at delivery. Sonography correctly identified the presence of placenta accreta in 14 of 15 patients (93% sensitivity; 95% confidence interval [CI], 80%–100%) and the absence of placenta accreta in 12 of 17 patients (71% specificity; 95% CI, 49%–93%). Magnetic resonance imaging correctly identified the presence of placenta accreta in 12 of 15 patients (80% sensitivity; 95% CI, 60%–100%) and the absence of placenta accreta in 11 of 17 patients (65% specificity; 95% CI, 42%–88%). In 7 of 32 cases, sonography and MRI had discordant diagnoses: sonography was correct in 5 cases, and MRI was correct in 2. There was no statistical difference in sensitivity (P = .25) or specificity (P = .5) between sonography and MRI. Conclusions. Both sonography and MRI have fairly good sensitivity for prenatal diagnosis of placenta accreta; however, specificity does not appear to be as good as reported in other studies. In the case of inconclusive findings with one imaging modality, the other modality may be useful for clarifying the diagnosis.     

Incidence of Pericardial Effusion in Patients Presenting to the Emergency Department with Unexplained Dyspnea

OBJECTIVE: To evaluate the frequency of pericardial effusion in patients presenting to the emergency department (ED) with unexplained, new onset dyspnea. METHODS: This prospective observational study took place at an urban community hospital ED with a residency program and an annual census of 65,000 visits. Patients presenting between May 1999 and January 2000 with new-onset dyspnea were eligible if they lacked any pulmonary, infectious, hematological, traumatic, psychiatric, cardiovascular, or neuromuscular explanation for their dyspnea after ED evaluation. Patients received a focused echocardiogram by certified emergency physicians. Data were recorded on standardized data sheets and studies were taped for review. Effusions were categorized as small when the fluid stripe measured less than 10 mm. Moderate-sized effusions measured 10 to 15 mm. Large effusions measured more than 15 mm. RESULTS: One hundred three patients were enrolled. Median age was 56 years (IQR 44, 95% CI = 32 to 67). Fourteen patients (13.6%, 95% CI = 8% to 23%) had effusions. Four had large effusions that explained their dyspnea and were admitted to cardiology; two of these effusions were hemorrhagic, and two were viral in origin. Seven patients with small effusions were treated conservatively at home. Three patients had moderate-sized effusions; all were admitted but treated conservatively. CONCLUSIONS: While limited by small numbers, these preliminary data suggest that patients with unexplained dyspnea should be checked for pericardial effusion when bedside ED ultrasound is available.     

Learning Curve of Emergency Physicians Using Emergency Bedside Sonography for Symptomatic First‐Trimester Pregnancy

Objective. The purpose of this study was to prospectively assess the learning curve of emergency physician training in emergency bedside sonography (EBS) for first‐trimester pregnancy complications. Methods. This was a prospective study at an urban academic emergency department from August 1999 through July 2006. Patients with first‐trimester vaginal bleeding or pain underwent EBS followed by pelvic sonography (PS) by the Department of Radiology. Results of EBS were compared with those of PS using a predesigned standardized data sheet. Results. A total of 670 patients underwent EBS for first‐trimester pregnancy complications by 1 of 25 physicians who would go on to perform at least 25 examinations. The sensitivity and specificity of EBS for an intrauterine pregnancy increased from 80% (95% confidence interval [CI], 71%–87%) and 86% (95% CI, 76%–93%), respectively, for a physician's first 10 examinations to 100% (95% CI, 73%–100%) and 100% (95% CI, 63%–100%) for those performed after 40 examinations. Likewise, the sensitivity and specificity for an adnexal mass or ectopic pregnancy changed from 43% (95% CI, 28%–64%) and 94% (95% CI, 89%–97%) to 75% (95% CI, 22%–99%) and 89% (95% CI, 65%–98%), whereas the sensitivity and specificity for a molar pregnancy changed from 71% (95% CI, 30%–95%) and 98% (95% CI, 94%–99%) to 100% (95% CI, 20%–100%) and 100% (95% CI, 81%–100%). Although detection of an intrauterine or a molar pregnancy improved with training, even with experience including 40 examinations, the sensitivity of EBS for an adnexal mass or ectopic pregnancy was less than 90%. Conclusions. There is an appreciable learning curve among physicians learning to perform EBS for first‐trimester pregnancy complications that persists past 40 examinations.     

Prospective validation of the bedside sonographic acute cholecystitis score in emergency department patients

BackgroundAcute cholecystitis can be difficult to diagnose in the emergency department (ED); no single finding can rule in or rule out the disease. A prediction score for the diagnosis of acute cholecystitis for use at the bedside would be of great value to expedite the management of patients presenting with possible acute cholecystitis. The 2013 Tokyo Guidelines is a validated method for the diagnosis of acute cholecystitis but its prognostic capability is limited. The purpose of this study was to prospectively validate the Bedside Sonographic Acute Cholecystitis (SAC) Score utilizing a combination of only historical symptoms, physical exam signs, and point-of-care ultrasound (POCUS) findings for the prediction of the diagnosis of acute cholecystitis in ED patients.MethodThis was a prospective observational validation study of the Bedside SAC Score. The study was conducted at two tertiary referral academic centers in Boston, Massachusetts. From April 2016 to March 2019, adult patients (≥18 years old) with suspected acute cholecystitis were enrolled via convenience sampling and underwent a physical exam and a focused biliary POCUS in the ED. Three symptoms and signs (post-prandial symptoms, RUQ tenderness, and Murphy's sign) and two sonographic findings (gallbladder wall thickening and the presence of gallstones) were combined to calculate the Bedside Sonographic Acute Cholecystitis (SAC) Score. The final diagnosis of acute cholecystitis was determined from chart review or patient follow-up up to 30 days after the initial assessment. In patients who underwent operative intervention, surgical pathology was used to confirm the diagnosis of acute cholecystitis. Sensitivity, specificity, PPV and NPV of the Bedside SAC Score were calculated for various cut off points.Results153 patients were included in the analysis. Using a previously defined cutoff of ≥ 4, the Bedside SAC Score had a sensitivity of 88.9% (95% CI 73.9%–96.9%), and a specificity of 67.5% (95% CI 58.2%–75.9%). A Bedside SAC Score of < 2 had a sensitivity of 100% (95% CI 90.3%–100%) and specificity of 35% (95% CI 26.5%–44.4%). A Bedside SAC Score of ≥ 7 had a sensitivity of 44.4% (95% CI 27.9%–61.9%) and specificity of 95.7% (95% CI 90.3%–98.6%).ConclusionA bedside prediction score for the diagnosis of acute cholecystitis would have great utility in the ED. The Bedside SAC Score would be most helpful as a rule out for patients with a low Bedside SAC Score < 2 (sensitivity of 100%) or as a rule in for patients with a high Bedside SAC Score ≥ 7 (specificity of 95.7%). Prospective validation with a larger study is required.     

Diagnostic Accuracy of Sonographic and Clinical Parameters in the Prediction of Retained Products of Conception

Objective. The purpose of this study was to assess the diagnostic accuracy of different parameters (clinical and sonographic) in the prediction and management of retained products of conception (RPOC) in the late postpartum period. Methods. This was a prospective cohort 3‐year audit. Predefined data were collected and compared with histopathologic (HP) reports after uterine evacuation. The primary outcome measure was the diagnostic accuracy of different clinical and sonographic parameters, including color Doppler imaging in diagnosis of RPOC confirmed on HP reports. Secondary outcome measures were complication rates influencing maternal morbidity. Results. In total, 93 patients (0.92% of all deliveries) were selected. The presence of gestational tissue was confirmed on HP reports in 58% of cases. The likelihood ratio of sonography alone was 1.47 (95% confidence interval, 1.25–1.84), whereas that of sonography combined with color Doppler imaging was 2.16 (1.3–3.59), providing statistically significant accuracy regarding the prediction of RPOC. Conclusions. Sonography alone or combined with color Doppler imaging has better diagnostic accuracy than the usual clinical parameters used for the prediction of RPOC.     

Sonography in the Evaluation of Acute Appendicitis

Objective. The purpose of this study was to evaluate the negative predictive value (NPV) of sonography in the diagnosis of acute appendicitis. Methods. Right lower quadrant sonograms of 193 patients (158 female and 35 male; age range, 3–20 years) with suspected acute appendicitis over a 1‐year period were retrospectively reviewed. Sonographic findings were graded on a 5‐point scale, ranging from a normal appendix identified (grade 1) to frankly acute appendicitis (grade 5). Sonographic findings were compared with subsequent computed tomographic (CT), surgical, and pathologic findings. The diagnostic accuracy of sonography was assessed considering surgical findings and clinical follow‐up as reference standards. Results. Forty‐nine patients (25.4%) had appendicitis on sonography, and 144 (74.6%) had negative sonographic findings. Computed tomographic scans were obtained in 51 patients (26.4%) within 4 days after sonography. These included 39 patients with negative and 12 with positive sonographic findings. Computed tomography changed the sonographic diagnosis in 10 patients: from negative to positive in 3 cases and positive to negative in 7. Forty‐three patients (22.2%) underwent surgery. The surgical findings were positive for appendicitis in 37 (86%) of the 43 patients who had surgery. Patients with negative sonographic findings who, to our knowledge, did not have subsequent CT scans or surgery were considered to have negative findings for appendicitis. Seven patients with negative sonographic findings underwent surgery and had appendicitis; therefore, 137 of 144 patients with negative sonographic findings did not have appendicitis. On the basis of these numbers, the NPV was 95.1%. Conclusions. Sonography has a high NPV and should be considered as a reasonable screening tool in the evaluation of acute appendicitis. Further imaging could be performed if clinical signs and symptoms worsen.     

Factors influencing inappropriate use of ED visits among type 2 diabetics in an evidence‐based management programme

Object This study analyses inappropriate use of emergency department (ED) services among type 2 diabetics under an evidence‐based management programme. Methods Using 1999‐2006 databases of Louisiana Health Care Services Division (HCSD) eight public hospitals ED visits among the uninsured and other patients in Louisiana, we termed urgent ED visits appropriate and less‐urgent visits inappropriate. Eliminating weekend ED visits, 17 458 urgent and 22 395 less‐urgent visits by 8596 patients were analysed, using generalized estimating equation methods. Results Caucasians were 0.82 times (95% CI: 0.751–0.889) less likely to use the ED inappropriately compared with African Americans. Patients with commercial insurance, Medicaid and Medicare used the ED more inappropriately than uninsured, with odds ratios of 1.28, 1.32 and 1.28, respectively. Patients hospitalized the prior year were 0.84 times (95% CI: 1.08–1.31) less likely for inappropriate. Patients in larger hospitals used the ED more inappropriately, with an odds ratio of 1.44 (95% CI: 1.32–1.56). Conclusions The study suggests that inappropriate use of the ED among diabetic patients in an evidence‐based management programme is more likely to occur among African American, patients with insurance coverage and those seeking care in larger hospitals. Reinforcing the regular use of clinic services for diabetes management, providing clinic access in off‐hours, and engaging the health plans in providing incentives for more appropriate use of the ED might reduce inappropriate ED visits. Notably, uninsured patients with diabetes from HCSD were more efficient users of the ED.     

Utility of the blood urea nitrogen to serum albumin ratio as a prognostic factor of mortality in aspiration pneumonia patients

PurposeThis study aimed to determine whether the blood urea nitrogen to serum albumin (B/A) ratio is a useful prognostic factor of mortality in patients with aspiration pneumonia.MethodsThe study included patients with aspiration pneumonia who had been admitted to our hospital via the emergency department (ED) between January 1, 2014 and December 31, 2018. The 28-day mortality after the ED visits was the primary end point of this study. The data of the survivors and non-survivors were compared.ResultsA final diagnosis of aspiration pneumonia was made for 443 patients during the study period. Significant differences were observed in age, respiratory rate, albumin levels, total protein levels, blood urea nitrogen levels, C-reactive protein levels, glucose, and Charlson comorbidity index scores between the survivor and non-survivor groups. Moreover, the B/A ratio was significantly higher in the non-survivor group than that in the survivor group.The area under the curve for the B/A ratio was 0.70 [95% confidence interval (CI) 0.65–0.74], 0.71 for the PSI (95% CI 0.67–0.76), 0.64 for CURB-65 (95% CI 0.60–0.69), and 0.65 for albumin (95% CI 0.60–0.70) on the receiver operating characteristic curve for predicting mortality within 28 days of the ED visit. Multivariable logistic regression analysis revealed that the B/A ratio (>7, OR 3.40, 95% CI 1.87–6.21, P < 0.001) was associated with mortality within 28 days of the ED visit.ConclusionThe B/A ratio is a simple and potentially useful prognostic factor of mortality in aspiration pneumonia patients.     

Gaucher Disease

Objective. Our large tertiary clinic for patients with Gaucher disease has used sonography as the preferred modality to monitor hepatosplenomegaly in hundreds of patients for more than 18 years. With the advent of specific enzyme replacement therapy (ERT), sonographic monitoring of changes in both hepatomegaly and the echogenicity of the hepatic tissue may highlight features that are amenable to ERT. Methods. All patients (500) seen at presentation and at annual or semiannual routine visits have undergone sonographic examinations by a single senior radiologist (I.H.‐H.). Results. Thirty‐nine patients (7.8%) had sonographic evidence of hepatic disease (21 male and 18 female; age range, 18–90 years); 26 (66.7%) of these received ERT, and 10 (25.6%) were splenectomized. Conclusions. Liver findings are relatively rare. Among 500 patients, there was no instance of computed tomographic findings that had not been previously shown by sonography. Radiologists should be acquainted with the variable sonographic spectrum of the Gaucher liver. If hepatic lesions are small, hyperechoic, and slowly evolving, one may surmise that they are due to Gaucher cell accumulation. However, special attention should be paid to progressive deterioration and irregularities in liver texture because other metabolic processes and cancers must be ruled out.     

Association between adopting emergency department crowding interventions and emergency departments' core performance measures

ObjectivesTo estimate the association between adopting emergency department (ED) crowding interventions and emergency departments' core performance measures.MethodsWe analyzed the National Hospital Ambulatory Medical Care Survey (NHAMCS) data from 2007 to 2015. The outcome variables are ED length of stay for discharged and admitted patients, boarding time, wait time and percentage of patients who left ED before being seen (LWBS). The independent variables are whether or not a hospital adopted each of the 20 crowding interventions. Controlling for patient-level, hospital level and temporal confounders we analyze and report results using multivariable logit model.ResultsBetween 2007 and 2015, NHAMCS collected data for 269,721 ED visit encounters, representing a nationwide of about 1.18 billion separate ED visits. Of 20 crowding interventions we tested, using adopting bedside registration (OR = 0.89, 95% CI = 0.75–0.98, P < .05), electronic dashboard (OR = 0.86, 95% CI = 0.76–0.98, P < .05), kiosk check-in technology (OR = 0.56, 95% CI = 0.41–0.83, P < .001), physician based triage (OR = 0.86, 95% CI = 0.73–0.99, P < .05) full capacity protocol (OR = 0.91, 95% CI = 0.79–0.99, P < .05) are associated with decrease in the odds of prolonged wait time. Adopting kiosk check-in (OR = 0.55, 95% CI = 0.35–0.85, P < .05) is associated with a decrease in the odds of prolonged boarding time. Using wireless communication devices (OR = 0.77, 95% CI = 0.57–0.97, P < .05), bedside registration (OR = 0.77, 95% CI = 0.64–0.094, P < .05) and pooled nursing (OR = 0.84, 95% CI = 0.72–0.98, P < .05) are associated with decrease in the odds of a patient LWBS.ConclusionsMajority of interventions did not significantly associated with ED' core performance measures.     

Echogenic Intracardiac Foci

Objective. The purpose of this study was to evaluate the impact of an echogenic intracardiac focus (EIF) on the risk for fetal trisomy 21 (T21) in populations with differing prevalence of T21. Methods. A retrospective cohort study of pregnancies presenting to our prenatal ultrasound units over 16 years (1990–2006) was conducted. Contingency table analysis of the presence of an EIF and diagnosis of fetal T21 was performed. The groups analyzed included the following: (1) all fetuses with EIF plus other sonographic markers, (2) EIF as an isolated sonographic marker, (3) those younger than 35 years with an isolated finding of EIF, and (4) a group with an isolated finding of EIF excluding those at increased risk for T21 on serum screening. Results. Echogenic intracardiac foci were found in 2223 of 62,111 pregnancies (3.6%), and T21 was diagnosed in 218 pregnancies (0.4%). The presence of an EIF along with other markers was associated with a statistically significant risk for T21 (positive likelihood ratio [LR], 4.4; 95% confidence interval [CI], 3.2–6.0; P < .05). An isolated EIF was not associated with a statistically significant increased risk for T21 in patients younger than 35 years (positive LR, 1.7; 95%, CI 0.7–4.1) and those without abnormal serum screening results for aneuploidy (positive LR, 1.6; 95% CI, 0.8–3.1). Conclusions. The finding of an isolated EIF on prenatal sonography does not significantly increase the risk for fetal T21 in populations not otherwise at an increased risk for the disorder. An isolated EIF should be considered an incidental finding in patients younger than 35 years and in those without abnormal serum aneuploidy screening results.     

Usefulness of Renal Volume Measurements Obtained by a 3‐Dimensional Sonographic Transducer With Matrix Electronic Arrays

Objective. The purpose of this study was to examine the feasibility of 3‐dimensional (3D) sonography using a matrix array transducer to measure renal volume. Methods. One hundred consecutive patients with a normal serum creatinine level and kidney appearance on computed tomography (CT) performed within 2 months before sonography were enrolled in this study. Two hundred individual renal volumes were blindly obtained by the ellipsoid formula, the stacked ellipse method, the voxel count method using routine 2‐dimensional (2D) sonographic data, 3D sonographic data using a matrix array transducer, and CT data, respectively. The voxel count method was validated as the reference standard by the water displacement method in 10 cadaveric pig kidneys (r = 0.99; P < .001). Renal volumes determined by 2D and 3D sonography were compared with volumes determined by CT. Results. Volumes determined by 2D sonography were significantly lower than those determined by CT (P < .001) but similar to those determined by 3D sonography (P = .78). The percent volume error of 3D sonography (mean ± SD, ?2.2% ± 3.7%) was significantly lower than that of 2D sonography (?15.7% ± 11.8%) with CT as the standard (P < .001). The correlation coefficient between 3D sonography and CT (r = 0.98; P < .0001) was better than that between 2D sonography and CT (r = 0.83; P < .0001). In addition, Bland‐Altman analysis revealed that the limits of agreement between 3D sonography and CT (?9.7% to 5.1%) were narrower than those between 2D sonography and CT (?45.6% to 9.8%). Conclusions. Three‐dimensional sonography with a matrix array transducer can significantly reduce renal volume measurement errors and offers a reliable means of determining renal volumes.     

The accuracy of bedside USG in the diagnosis of nasal fractures

A comparison of the sensitivity and specificity of bedside ultrasonography with conventional radiography for the evaluation of nasal fractures.

Timed Up and Go test is not useful as a discharge risk screening tool

Objective: To determine whether the ‘Timed Up and Go’ (TUG) test is a useful test for predicting re‐attendance at an ED, emergency hospital admission or death within 90 days in elderly patients discharged from the ED. Methods: This was a prospective blinded cohort study at a tertiary referral ED. Patients completed a TUG test during their Allied Health assessment prior to discharge from the department. After 90 days, patient ED attendances, emergency admissions to hospital or deaths were recorded and confirmed by phone. Data were analysed using logistic regression and reported as odds ratios (OR) or log‐transformation and Pearson analysis. Results: One hundred patients were enrolled: 78 (78%, 95% confidence interval [CI] 70–86%) patients remained event free, 22 (22%, 95% CI 14–30%) patients re‐attended an ED and 15 (15%, 95% CI 8–22%) were admitted to hospital as an emergency admission. There was no significant difference between TUG test times and whether patients re‐attended an ED (OR 1.0 [0.93–1.06]P = 0.9) or were admitted to hospital (OR 0.99 [0.91–1.07]P = 0.74). There was no significant correlation between a patient's TUG test time and the number of days to ED re‐attendance (Pearson correlation coefficient 0.38 [?0.04 to 0.69]P = 0.08) or admission (Pearson correlation coefficient 0.32 [?0.23 to 0.71]P = 0.25). Conclusion: This study did not detect any predictive value of the TUG test for ED re‐attendance or hospital admission within 90 days of discharge among aged ED patients.