Emergency Ultrasound Training Program in Guyana: Systematic Credentialing Process in a Resource-limited Setting

Evaluation of an emergency medicine point-of-care ultrasound curriculum adapted for a resource-limited setting in Guyana

BACKGROUND

This is a cohort pilot study of senior emergency medicine residents and residency-trained emergency medicine registrars practicing in an urban tertiary academic hospital in Guyana in South America. The primary aim was to assess the effectiveness of the current adapted residency ultrasound training curriculum and guide future ultrasound-specific continuing medical education. Ultrasound image acquisition, interpretation, and integration of ultrasound findings into clinical medical decision-making competency were assessed in a multimodal fashion: a written assessment and a practical assessment.

METHODS

This was a cross-sectional cohort pilot study of senior emergency medicine residents and registrars (residency graduates) practicing in Guyana, a low-middle-income country. Ultrasound image acquisition and interpretation competency were assessed in a multimodal fashion: a written assessment and a practical assessment. The results will be reported as simple percentages. Participants will be deemed competent if the combined score is greater than 80% on the assessment.

RESULTS

All senior residents and graduates of the residency program were competent in the core point-of-care ultrasound applications. The senior residents averaged 89% proficiency, and the residency graduates subdivided based on years since graduation averaged 87-100% proficiency. The more experienced providers performed better on the practical portion of the evaluation. Evaluating the composite analysis of all the participants revealed the Extended Focused Assessment with Sonography in Trauma (EFAST) exam (96%) and cardiac exam (93%) were done with the most proficiency.

CONCLUSION

The assessment results of this pilot study suggest that the current residency ultrasound training curriculum adapted to the resources available is associated with sustained competency after graduation. There was minor attrition of knowledge amongst the senior physicians, but all senior residents and all participating residency graduates were competent in the core ultrasound applications.

Systematic Sonography Looking for Occult Wounds: accuracy of an abdominal ultrasound adjunct in penetrating trauma

BACKGROUND

Systematic Sonography Looking for Occult Wounds (SSLOW) in trauma is a novel technique for the evaluation of intra-abdominal wounds in penetrating trauma. No data exist regarding the effectiveness. The objective of this study was to evaluate the accuracy of the SSLOW exam.

METHODS

This is a prospective collected case series conducted over a period of 10 months and took place at the Accident and Emergency Department (A&E) of the Georgetown Public Hospital Corporation (GPHC). The study enrolled patients presenting to the A&E who were 16 years old or greater with penetrating abdominal trauma. All patients with penetrating trauma received an E-FAST examination. If the E-FAST examination was negative, a SSLOW examination was completed. The sonographer evaluated for free fluid collection between the loops of bowel. The results of the SSLOW were compared to usual care (surgery consult, serial abdominal and E-FAST exams, laparotomy, and 7-day follow-up) and then categorized into four groups: true positive, false positive, true negative, and false negative. These results lead to four categorical values. From these results, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios were calculated.

RESULTS

There were 5 (12%) true positives, 1 (2%) false positive, 37 (86%) true negatives, and zero (0%) false negative. The SSLOW was 100% sensitive (95% CI 5-100%) and 97% specificity (95% CI 74-96%). There was an 80% positive predictive value (95% CI 1.0-64% 95% CI) and 100% negative predictive value (95% CI 88-100%). The positive likelihood ratio was 8.4 (95% CI 3.69-19.1) and negative likelihood ratio was 0.

CONCLUSION

The SSLOW examination may be a useful tool in the evaluation of penetrating abdominal injuries.

Observational descriptive study of ultrasound use and its impact on clinical decisions in the accident and emergency department at Georgetown public hospital corporation

Introduction

Point-of-care ultrasound (POCUS) is physician-performed at the bedside, and it is a powerful diagnostic tool, especially in resource-limited emergency medicine healthcare settings. This study aims to quantify both the use of ultrasound and its impact on patient care at the Accident and Emergency Department at the Georgetown Public Hospital Corporation (GPHC).

Methods

This is a cross-sectional observational descriptive analysis of data collected for quality assessment in the GPHC Accident and Emergency Department. Over the course of two months, physicians were asked to record each ultrasound exam performed and record whether the ultrasound results changed patient disposition or the medication used in management.

Results

During the study period, there were 173 ultrasound data sheets collected representing 426 ultrasound studies. 196 studies were positive with pathologic findings (46.0%). The use of ultrasound in patient care either changed the patient’s final disposition or medication 78.6% of the time.

Conclusion

Ultrasound is used frequently at the Georgetown Public Hospital Corporation for a wide variety of applications. When utilized, POCUS frequently influenced patient care.