Emergency ultrasound credentialling for focused assessment sonography in trauma and abdominal aortic aneurysm: A practical approach for Australasia

Objective: Focused assessment with sonography for trauma and emergency ultrasound for abdominal aortic aneurysm are now practiced widely by non‐radiologists in emergency departments worldwide. Various credentialling programs have been proposed for novice sonographers; however, their feasibility has been questioned. We adopted the Australasian College for Emergency Medicine (ACEM) credentialling process for emergency ultrasound to determine whether it is feasible for emergency physicians in the Australasian environment. Methods: Three full‐time emergency medicine specialists and a post‐Fellowship Examination trainee at Auckland Hospital undertook the credentialling process. Results: All four participants had sufficient scans to complete the process after 16 months. Accuracy for focused assessment with sonography for trauma, 90% (95% CI 83–95%), and abdominal aortic aneurysm, 99% (95% CI 90–100%), is similar to that previously reported. Conclusion: The ACEM credentialling process for focused assessment with sonography for trauma and abdominal aortic aneurysm is practical and achievable for emergency medicine specialists working in the Emergency Department at Auckland Hospital. Further studies are necessary to determine whether this holds true for other major trauma centres in Australasia.     

Emergency ultrasound in the acute assessment of haemothorax

Aims: To evaluate thoracic ultrasound for the detection of haemothorax in patients with thoracic trauma against established investigations.

Methods: Thoracic ultrasound was performed as an extension of the standard focused assessment with sonography for trauma (FAST) protocol used at the Queen's Medical Centre for the assessment of adult patients with torso trauma. Fluid was sought in both pleural cavities using a hand portable ultrasound system by one of two non-radiologists trained in FAST. Findings were compared against subsequent investigations/procedures performed at the discretion of the attending emergency physician—supine chest radiography, intercostal drain, computed tomography, or thoracotomy. The sensitivity of the technique and the time taken to diagnosis for each investigation were recorded.

Results: Sixty one patients, 54 (89%) after blunt trauma, underwent thoracic ultrasound evaluation during the study. Twelve patients had a haemothorax detected by ultrasound and confirmed by computed tomography or by tube thoracostomy. Four haemothoraces detected on ultrasound were not apparent on trauma chest radiography. There were 12 true positives, 48 true negatives, no false positives, and one false negative scan. The sensitivity of ultrasound was 92% and specificity 100% with a positive predictive value of 100% and negative predictive value 98% for the detection of haemothorax after trauma.

Conclusions: Emergency ultrasound of the chest performed as part of the primary survey of the traumatised patient can rapidly and accurately diagnose haemothorax and is a valuable tool to augment the immediate clinical assessment of these patients.

     

Systematic Sonography for Detection of Occult Wounds in Trauma

Treating victims of penetrating trauma is challenging, especially in a mass‐casualty or resource‐limited setting. The traditional focused assessment with sonography for trauma examination is a well‐established clinical tool in the initial evaluation of trauma victims. This article describes a novel technique of systematic sonography of the abdomen to look for occult wounds, which is used in conjunction with the focused assessment with sonography for trauma examination to evaluate occult intraperitoneal injury and improve patient treatment and use of resources. The technique is highlighted in a case of a child injured in a conflict zone in northern Iraq.     

What is needed for Trauma Informed Mental Health Services in Australia? Perspectives of clinicians and managers

Trauma Informed Care is an approach to the delivery of mental health care that requires sensitivity to the prevalence and effects of trauma in the lives of people accessing services. While TIC is increasingly emphasized in mental health policy and frameworks in Australia, people working in mental health settings have reportedly struggled to translate the values and principles into their everyday practice. This qualitative study used an experience‐based co‐design methodology to explore the potential for implementation of Trauma Informed Care into mental health services in Australia. The experiences of consumers, carers, clinicians, and managers were gathered. This paper presents the perspectives of clinicians (n = 64) and senior managers (n = 9) from across three Local Health Districts in New South Wales in Australia. All data were analysed thematically to address the research question: What is needed for Trauma Informed Mental Health Services in Australia? To be trauma‐informed, managers required: leadership at all levels, access to resource, relevant and accessible training, support for staff, resolution of wider systems issues, and clarification of the concept and actions of TIC. Clinicians identified that to be trauma‐informed they required services to: be aware of staff well‐being, support different ways of working, address workplace cultures and provide increased resources. The findings have implications for any service, team or individual seeking to implement TIC within mental health settings.     

急诊床旁应用超声FAST方案快速评估多发伤的初步研究

目的 研究急诊床旁应用超声FAST方案快速评估多发伤的临床价值.方法 2008年6月至2009年10月,浙江大学医学院附属第二医院急诊科收治的严重多发伤患者,共97例.男性72例,女性25例.年龄14～88岁,(41±16)岁.损伤严重度评分(ISS)14～38分,(23.2±9.3)分.纳入标准:①年龄≥14岁;②受伤12 h内;③直接进入急诊复苏室.排除标准:①2 d内死亡且未行腹部CT扫描或剖腹探查;②经FAST评估后直接手术治疗而未行常规超声检查.对研究对象的不同评估方法进行前瞻性对照研究.所有病例均由急诊医生应用超声FAST方案进行腹腔及心包评估,部位包括剑突下四腔心切面、右隔下及肝肾间隙、右结肠旁沟、左隔下及脾肾间隙、左结肠旁沟、盆腔,根据有无游离液体判断腹腔及心包是否有损伤.同时与常规超声检查、CT扫描及手术结果进行比较.FAST与常规超声耗时比较用配对资料t检验,两者检查结果一致性用配对McNemar检验,计算FAST与常规超声的特异度、敏感性、阳性预测值、阴性预测值、假阳性率、假阴性率、准确率.两者率的比较用Fisher检验.结果 FAST耗时1～6min,(3.18±0.79)min,显著短于常规超声检查(16.63±4.62)min,(t=28.61,P＜0.01).97例患者中,FAST阳性者11例,阴性者86例,其中4例为假阴性.与常规超声结果比较差异无统计学意义(P=0.5).从诊断效能看,以CT及手术结果作为金标准,FASST的敏感性为73%,特异性为100%,阳性预测值100%,假阳性率为0,阴性预测值为95.3%,假阴性率为4.6%,总准确率为95.9%,与常规超声相比,差异无统计学意义.结论 只要经过适当培训,急诊科医生完全可以掌握FAST技术,对严重创伤患者腹部损伤及心包作出快速准确的判断.     

A Potential Pitfall of Using Focused Assessment With Sonography for Trauma in Pediatric Trauma

Prospective studies have shown sensitivities of 73% to 88% and specificities of 98% to 100% for using the focused assessment with sonography for trauma (FAST) examination to identify free fluid in adult trauma patients. However, the efficacy of FAST examinations for pediatric trauma patients has not been well defined, and studies looking at diagnostic performance have had varied results. We describe 3 cases of the potential pitfalls of the pediatric FAST examination in pediatric trauma patients using an advanced‐processing ultrasound machine. We hypothesize several etiologies for these false‐positive findings in the setting of advanced image‐processing capabilities of point‐of‐care ultrasound. We also discuss the reevaluation of clinical algorithms and interpretation practices when using the FAST examination in pediatric trauma.     

FAST (Focused Assessment With Sonography in Trauma) Accurate for Cardiac and Intraperitoneal Injury in Penetrating Anterior Chest Trauma

Objective. To evaluate the FAST (focused assessment with sonography in trauma) examination for determining traumatic pericardial effusion and intraperitoneal fluid indicative of injury in patients with penetrating anterior chest trauma. Methods. An observational prospective study was conducted over a 30‐month period at an urban level I trauma center. FAST was performed in the emergency department by emergency physicians and trauma surgeons. FAST results were recorded before review of patient outcome as determined by 1 or more of the following: thoracotomy, laparotomy, pericardial window, cardiologic echocardiography, diagnostic peritoneal lavage, computed tomography, and serial examinations. Results. FAST was undertaken in 32 patients with penetrating anterior chest trauma: 20 (65%) had stab wounds, and 12 (35%) had gunshot wounds. Sensitivity of FAST for cardiac injury (n = 8) in patients with pericardial effusion was 100% (95% confidence interval, 63.1%–100%); specificity was 100% (95% confidence interval, 85.8%–100%). The presence of pericardial effusion determined by FAST correlated with the need for thoracotomy in 7 (87.5%) of 8 patients (95% confidence interval, 47.3%–99.7%). One patient with a pericardial blood clot on cardiologic echocardiography was treated nonsurgically. FAST had 100% sensitivity for intraperitoneal injury (95% confidence interval, 63.1%–100%) in 8 patients with views indicating intraperitoneal fluid but without pericardial effusion, again with no false‐positive results, giving a specificity of 100% (95% confidence interval, 85.8%–100%). This prompted necessary laparotomy in all 8. Conclusions. In this series of patients with penetrating anterior chest trauma, the FAST examination was sensitive and specific in the determination of both traumatic pericardial effusion and intraperitoneal fluid indicative of injury, thus effectively guiding emergent surgical decision making.     

Image Segmentation and Machine Learning for Detection of Abdominal Free Fluid in Focused Assessment With Sonography for Trauma Examinations

The objective of this pilot study was to test the feasibility of automating the detection of abdominal free fluid in focused assessment with sonography for trauma (FAST) examinations. Perihepatic views from 10 FAST examinations with positive results and 10 FAST examinations with negative results were used. The sensitivity and specificity compared to manual classification by trained physicians was evaluated. The sensitivity and specificity (95% confidence interval) were 100% (69.2%–100%) and 90.0% (55.5%–99.8%), respectively. These findings suggest that computerized detection of free fluid on abdominal ultrasound images may be sensitive and specific enough to aid clinicians in their interpretation of a FAST examination.     

Residents Should Not Independently Perform Focused Abdominal Sonography for Trauma After 10 Training Examinations

Objectives. To assess whether 10 focused abdominal sonography for trauma (FAST) examinations could be used as a minimum standard for training, as suggested previously. Methods. This was a retrospective review of patients with abdominal trauma who underwent resident‐performed FAST examinations before surgical or Department of Radiology evaluation. Results. Six hundred ninety‐eight patients were examined by resident‐performed FAST followed by reference standard evaluations. Four hundred twelve patients were evaluated by residents who previously performed 10 FAST examinations; 154 were evaluated by 29 residents performing their 11th through 30th examinations; and 258 were evaluated by 10 residents performing their 31st and subsequent examinations. The results of resident‐performed FAST for intraperitoneal free fluid were as follows: 11 to 20 examinations—sensitivity, 73.9% (95% confidence interval, 51.3%–88.9%); specificity, 98.8% (92.5%–99.9%); true‐positive findings, 17; true‐negative, 81; false‐positive, 1; false‐negative, 6; total patients, 105; 21 to 30 examinations—sensitivity, 100% (73.2%–100%); specificity, 97.1% (83.3%–99.9%); true‐positive, 14; true‐negative, 34; false‐positive, 1; false‐negative, 0; total patients, 49; 31 and more examinations—sensitivity, 94.8% (88.6%–97.9%); specificity, 98.6% (94.5%–99.8%); true‐positive, 110; true‐negative, 140; false‐positive, 2; false‐negative, 6; total patients, 258. Conclusions. The suggestion that 10 examinations could be used as a minimum standard for training in FAST examinations was not validated.     

Comparison of patient questionnaires, medical records, and plasma assays in assessing exposure to benzodiazepines in elderly subjects.

OBJECTIVE: Exposure in pharmacoepidemiologic studies can rely on various sources such as medical records, patient questionnaires, or plasma samples, which do not always concur. This study endeavored to compare sources of information on current exposure to benzodiazepines in elderly subjects. METHODS: In a study in a hospital admissions department, 1136 elderly subjects included in a case-control study each completed a structured questionnaire. In addition, an inspection of the medical records of each subject was performed, as well as screening of a plasma sample (high-pressure liquid chromatography--diode array detector) for current exposure to benzodiazepines. RESULTS: Benzodiazepines were found in the plasma of 33% of 1013 patients, in the records of 31% of patients, and in the questionnaires of 36% of 797 respondents. With use of the plasma results as a standard, questionnaires had 11% false positives and 28% false negatives; medical records had 14% false positives and 23% false negatives. The kappa for concordance between questionnaires and records was 0.63. Most of the errors were related to the unexpected presence in plasma of clorazepate, commonly used as a hypnotic agent. CONCLUSIONS: Patient recall and medical records are not reliable measures of current exposure to benzodiazepines in elderly persons, although this unreliability may be more marked with certain drugs used as hypnotic agents.     

Managing deteriorating patients with a physiotherapy critical care outreach service: A mixed-methods study

BackgroundCritical care outreach teams support ward staff to manage patients who are seriously ill or after discharge from the intensive care unit (ICU). Respiratory deterioration is a common reason for (re)admission to the ICU. Physiotherapists are health professionals with skills to address acute respiratory concerns. Experienced respiratory physiotherapists play a role in supporting junior clinicians, particularly in managing deteriorating patients on the ward.ObjectivesThe objective of this study was to evaluate a novel respiratory physiotherapy critical care outreach–style service. The primary objective was to describe service referrals and the patient cohort. Other objectives were to compare the effects of this model of care on ICU readmission rates to a historical cohort and explore clinician perceptions of the model of care and its implementation.MethodsA new physiotherapy model of care worked alongside an existing nurse-led outreach service to support physiotherapists with the identification and management of patients at risk of respiratory deterioration or ICU (re)admission. Purpose-built and pre-existing databases were used for prospective data collection and for a historical ICU readmissions control group. Questionnaires and semistructured group interviews were utilised to evaluate clinician satisfaction and perceptions.ResultsThe service accepted referrals for 274 patients in 6 months (on average 2.25/working day; commonly after trauma [29%] and abdominal surgery [19%]). During the implementation period of the model of care, fewer preventable respiratory ICU readmissions were reported (n = 1/20) than in the historical cohort (n = 6/19: Fisher's exact test, p < 0.05). Likelihood of respiratory ICU readmission, compared to all-cause readmissions, was not affected (intervention: 31%, historical control: 41%; odds ratio: 0.63 [95% confidence interval: 0.29 to 1.4]). Postimplementation surveys and focus groups revealed clinicians highly valued the support and perceived a positive impact on patient care.ConclusionsCritical care outreach–style physiotherapy services can be successfully implemented and are positively perceived by clinicians, but any effect on ICU readmissions is unclear.     

Comparison of the Accuracy and Reproducibility of Focused Abdominal Sonography for Trauma Performed by Emergency Medicine and Radiology Residents

We compared the diagnostic accuracy of emergency medicine residents (EMRs) and radiology residents (RRs) in performing focused abdominal sonography for trauma (FAST). The cohort in this prospective study comprised 200 unstable patients (163 males and 37 females; mean ± standard deviation of age, 34.3 ± 16.4 y) who presented with trauma. These patients were evaluated using FAST, first by EMRs and subsequently by RRs. Patients with positive FAST results underwent further diagnostic procedures such as computed tomography, diagnostic peritoneal lavage and laparotomy. Those with negative FAST results underwent clinical follow-up for 72 h until their condition deteriorated or they were discharged. Sensitivity, specificity, positive and negative predictive values and accuracy in evaluating free intraperitoneal fluid were 80%, 95%, 57%, 98% and 94% when FAST was performed by EMRs and 86%, 95%, 59%, 98% and 94% when FAST was performed by RRs. The level of agreement between EMRs and RRs was moderate (κ = 0.525). FAST is a useful screening tool for initial assessment of free abdominal fluid in patients with trauma. Our results indicate that EMRs can perform sonography on trauma patients as successfully as RRs.     

Estimation of the general practice workload of a metropolitan teaching hospital emergency department

Background: A transparent and easily replicated method of estimating the number of, and costs associated with, low acuity presentations to an emergency department is required to assist evaluation of the utilization of emergency department services. This study presents two independent estimates of the number of, and costs associated with, low acuity presentations to an emergency department. Methods: A retrospective analysis was conducted using emergency department information system data from a metropolitan mixed paediatric/adult teaching hospital emergency department/trauma centre. Low acuity patient presentation estimates were calculated by: Method one: The product of (A) total self‐referred presentations for triage categories three, four and five and (B) the difference between the self‐referred and general practitioner‐referred discharge rates from the emergency department. Total low acuity patient presentations = (A × B). Method two: Summing the number of self‐referrals with presenting problems never referred by general practictioners. Costs were calculated using Commonwealth cost weights. Results: Method one gave a low acuity patient estimate of 12.5% (95% CI 12.0–13.0%) and method two 10.6% (95% CI 10.2–11.0%) of total presentations. Costs were 10.5% (method one) and 8.5% (method two) of total costs. Adjusted for assessment time, costs were 6.8% (method one) and 5.5% (method two) of total costs. Low acuity patients were more common outside of normal working hours, method one: 14.4% (95% CI 13.5–15.2%) versus 10.0% (95% CI 9.4–10.6%), P < 0.001; method two: 11.4% (95% CI 10.9–12.0%) versus 8.5% (95% CI 7.8–9.2%), P < 0.001. Provision of alternative daily 0900–2400 general practice services would change low acuity patients by no more than 2–3% of total presentations and change low acuity patient costs by no more than 2% of total costs. Conclusions: Low acuity patients form a small, relatively constant part of the emergency department workload. The provision of alternative after‐hours services for low acuity patients would be unlikely to significantly reduce the overall work load of this metropolitan emergency department.     

Rapid Assessment of the Neonate With Sonography (RANS) Scan

The use of point‐of‐care sonography in clinical settings such as emergency medicine and intensive care units has increased, but adoption in neonatology has been slow. Unlike the focused assessment with sonography for trauma scan used in adults, a quick bedside scan to rapidly evaluate an acutely deteriorating neonate does not exist. The objective of our article is to introduce a focused bedside ultrasound scan that is easy to learn, rapidly performed, and relatively inexpensive.© 2018 by the American Institute of Ultrasound in Medicine     

The utility of focused assessment with sonography for trauma as a triage tool in multiple-casualty incidents during the second Lebanon war.

OBJECTIVE: The purpose of this study was to evaluate the role of focused assessment with sonography for trauma (FAST) as a triage tool in multiple-casualty incidents (MCIs) for a single international conflict. METHODS: The charts of 849 casualties that arrived at our level 1 trauma referral center were reviewed. Casualties were initially triaged according to the Injury Severity Score at the emergency department gate. Two-hundred eighty-one physically injured patients, 215 soldiers (76.5%) and 66 civilians (23.5%), were admitted. Focused assessment with sonography for trauma was performed in 102 casualties suspected to have an abdominal injury. Sixty-eight underwent computed tomography (CT); 12 underwent laparotomy; and 28 were kept under clinical observation alone. We compared FAST results against CT, laparotomy, and clinical observation records. RESULTS: Focused assessment with sonography for trauma results were positive in 17 casualties and negative in 85. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of FAST were 75%, 97.6%, 88.2%, 94.1%, and 93.1%, respectively. A strong correlation between FAST and CT results, laparotomy, and clinical observation was obtained (P < .05). CONCLUSIONS: In a setting of a war conflict-related MCI, FAST enabled immediate triage of casualties to laparotomy, CT, or clinical observation. Because of its moderate sensitivity, a negative FAST result with strong clinical suspicion demands further evaluation, especially in an MCI.     

急诊超声检查在创伤性血胸诊断中应用168例分析

目的:评估急诊超声检查在创伤性血胸诊断中的应用。方法:对168例胸部创伤病人进行了急诊胸部超声检查,并对其检查结果进行分析。结果:168例中26例阳性,142例阴性,无假阳性,假阴性2例。超声检查对创伤后血胸诊断的敏感性为93%,特异性为100%,阳性预测值为100%,阴性预测值为99%。检查时间明显短于胸片检查。结论:急诊超声检查能够迅速、准确地检查出胸部创伤病人中血胸的存在,对重症创伤病人的早期分类、诊断和治疗具有重要的参考价值,值得临床上推广应用。     

Comparison Between Exclusively Long‐Axis and Multiple‐Axis Sonographic Protocols for Screening of Rotator Cuff Lesions in Symptomatic Shoulders

Objective. The purpose of this study was to determine whether exclusively long‐axis sonography differs from a multiple‐axis scanning protocol as a screening tool for rotator cuff lesions in symptomatic shoulders when compared with magnetic resonance imaging (MRI). Methods. A total of 509 consecutive patients (mean age, 52.8 years) referred for MRI were also routinely evaluated by sonography. We initially performed exclusively long‐axis sonography and graded the rotator cuff as normal or abnormal. Patients subsequently underwent a full sonographic protocol using multiple‐axis views. Magnetic resonance imaging findings were compared with sonographic findings for both techniques. Results. The overall accuracy of sonography was greater than 90%. We found divergent results from different sonographic techniques in 34 patients. Of these, 8 were multiple‐axis false‐negative; 14 were exclusively long‐axis false‐negative; 6 were exclusively long‐axis false‐positive; and 6 were multiple‐axis false‐positive. All cases with divergent false‐negative findings on multiple‐axis sonography showed tendinosis on MRI. Causes for false‐negative findings on exclusively long‐axis sonography included tendinosis and partial‐thickness tears of the supraspinatus. No statistically significant difference was seen between both sonographic techniques compared with MRI in terms of accuracy, sensitivity, specificity, positive predictive value, and negative predictive value (P > .05). Conclusions. Sonography is reliable for detecting rotator cuff abnormalities. Exclusively long‐axis sonography seems appropriate as a screening tool for rotator cuff lesions in symptomatic shoulders.     

Use,Impact, Weaknesses,and Advanced Features of Search Functions for Clinical Use in Electronic Health Records: A Scoping Review

Objective  Although vast amounts of patient information are captured in electronic health records (EHRs), effective clinical use of this information is challenging due to inadequate and inefficient access to it at the point of care. The purpose of this study was to conduct a scoping review of the literature on the use of EHR search functions within a single patient''s record in clinical settings to characterize the current state of research on the topic and identify areas for future study. Methods  We conducted a literature search of four databases to identify articles on within-EHR search functions or the use of EHR search function in the context of clinical tasks. After reviewing titles and abstracts and performing a full-text review of selected articles, we included 17 articles in the analysis. We qualitatively identified themes in those articles and synthesized the literature for each theme. Results  Based on the 17 articles analyzed, we delineated four themes: (1) how clinicians use search functions, (2) impact of search functions on clinical workflow, (3) weaknesses of current search functions, and (4) advanced search features. Our review found that search functions generally facilitate patient information retrieval by clinicians and are positively received by users. However, existing search functions have weaknesses, such as yielding false negatives and false positives, which can decrease trust in the results, and requiring a high cognitive load to perform an inclusive search of a patient''s record. Conclusion  Despite the widespread adoption of EHRs, only a limited number of articles describe the use of EHR search functions in a clinical setting, despite evidence that they benefit clinician workflow and productivity. Some of the weaknesses of current search functions may be addressed by enhancing EHR search functions with collaborative filtering.     

Bacterial contamination in platelets: incremental improvements drive down but do not eliminate risk

BACKGROUND: Bacterial contamination of platelet components (PCs) remains an important cause of transfusion‐associated infectious risk. In 2004, Canadian Blood Services (CBS) implemented bacterial testing of PCs using the BacT/ALERT 3D system (bioMérieux). This system has been validated and implemented and continuous monitoring of culture rates allows gathering of data regarding true and false positives as well as false negatives. STUDY DESIGN AND METHODS: National data gathered between March 2004 and October 2010 from 12 CBS sites were analyzed to compare bacterial contamination rates across three platelet (PLT) preparation methods: apheresis, buffy coat, and PLT‐rich plasma. Data were compared before and after implementation of protocol changes that may affect bacterial detection or contamination rates. RESULTS: Initial positive rates among the three production methods were significantly different, with apheresis PCs being the highest. The rates of confirmed positives among production methods did not differ significantly (p = 0.668). Increasing sample testing volumes from 4 to 6 mL to 8 to 10 mL significantly increased the rate of initial positives, while confirmed positives increased from 0.64 to 1.63 per 10,000, approaching significance (p = 0.055). Changing the skin disinfection method from a two‐step to a one‐step protocol did not significantly alter the rate of confirmed positives. During the period of data analysis, eight false‐negative cases were reported, with five implicated in adverse transfusion reactions. CONCLUSION: Bacterial testing of PCs and implementation of improved protocols are incrementally effective in reducing the risk of transfusion of bacterially contaminated PLT concentrates; however, the continued occurrence of false‐negative results means the risk has not been eliminated.     

Resident-performed Compression Ultrasonography for the Detection of Proximal Deep Vein Thrombosis: Fast and Accurate

OBJECTIVES: To assess whether emergency medicine residents (EMRs) could quickly perform accurate compression ultrasonography (CUS) for the detection of proximal lower extremity deep vein thromboses (PLEDVTs) with minimal training. METHODS: A prospective, observational study using a convenience sample of patients presenting with signs and/or symptoms for PLEDVT. Vascular laboratory and department of radiology studies were considered the criterion standard. CUS of the femoral vessels was performed. Incompressibility or visualized thrombus was considered "positive." RESULTS: Eight residents with limited ultrasound (US) experience and no prior experience with deep vein thrombosis (DVT) US volunteered to participate in this study, enrolling 72 patients. Their average scan time was 11.7 minutes (95% CI = 9.4 to 14). There were 23 true positives, 4 false positives, 45 true negatives, and 0 false negatives. The test characteristics for PLEDVT gave a sensitivity of 100% (95% CI = 82.2 to 100) and a specificity of 91.8% (95% CI = 79.5 to 97.4). CONCLUSION: Emergency medicine residents with limited US experience were able to quickly perform CUS after minimal training for the detection of PLEDVT in a select group of patients.