Abstract Proceedings EROC 2011 - New York Osteopathic Medical ...

EROC 2011 Abstract Proceedings – March 4, 2011
Dept. of Emergency Medicine, Good Samaritan Hospital Medical Center, West Islip, NY
Title: EM Residents Use Bedside Ultrasound to Diagnose Appendicitis and Avoid the
Radiation of CT scans – The Effect of Feedback
Authors: Andrew Flanagan DO, Joseph Artale, DO, Ronald Dvorkin MD, Jason Idelson DO,
Diana Kontonotas DO, Andrew Mapley DO, David Teng MD, Steve Zimmerman MD
Objective: We wish to demonstrate that in many cases appendicitis can be reliably diagnosed by
Emergency Physicians and Residents with a bedside ultrasound examination in the Emergency
Department. We hypothesize that a pilot study can identify >30% of cases of appendicitis (as
compared to surgical pathology or CT scan if the case is managed non-surgically) with such
specificity (few false positives) such that CT scanning would not be required in >30% of cases of
appendicitis.
Methods: We developed a 4 hour ultrasound training module for Emergency Residents to
diagnose appendicitis. They were trained to identify a blind ended tubular and non-ovoid
structure >6mm that is not compressible. The residents were blinded to other clinical findings
and completed the data collection form before any other imaging studies were performed.
Patients were also contacted at 7 days to determine if there was any subsequent pathology.
Results: Initially we did not provide feedback to the residents. We found that they were not
comfortable with lack of feedback and had low sensitivity. After September 23, 2009 we chose
to give residents feedback after their data sheet was submitted. We found that the sensitivity
increased, but since this was a change in the protocol, the IRB has not permitted us to report
these subsequent results. Presently, the IRB has approved this changed protocol. We will report
our findings at the AOCEP Scientific Seminar in September.
Conclusion: Feedback may be useful in training Emergency Medicine Residents to reliably
identify appendicitis with bedside ultrasound. We will recruit 175 additional cases to determine
with a 95% certainty that the sensitivity is >30% and the specificity is >90%. If the findings can
be confirmed by our ongoing follow up study, then CT scans could be eliminated in some
patients and there would be the potential to decrease the lifetime risk of cancer in some of the
100,000 pediatric cases of appendicitis seen annually.
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