543 Sonographer and Radiologist Agreement for DVT and Gallbladder Ultrasound in the Emergency Department

Document Type

Conference Proceeding

Publication Date

9-1-2025

Publication Title

Ann Emerg Med

Abstract

Study Objectives: Prior studies have demonstrated high-rates of agreement between sonographer and radiologist interpretation of ultrasound images. In emergency medicine (EM), length of stay is an important quality measure. If the findings reported on sonographer worksheets are sensitive for conditions reported by radiologists, there may be opportunities to decrease length of stay. Methods: A retrospective study of adult patients (age 18+) presenting to the emergency departments at Henry Ford Providence Southfield and Novi was conducted, reviewing ultrasounds ordered for deep vein thrombosis (DVT) and abdominal studies ordered for cholelithiasis or cholecystitis. Sonographer worksheets were considered positive for cholecystitis if at least two of the following were documented: gallstones, positive Murphy’s sign, pericholecystic fluid, and gallbladder wall thickening. Radiologist reads were considered positive for cholecystitis if the interpretation was definitive or reported findings suggestive of cholecystitis, or if further imaging was recommended (ie, HIDA scan). Sample size calculations were performed based on an estimated 10% prevalence of disease, with an expected sensitivity of 95% for sonographer reads, using radiologist reads as the gold standard. The diagnostic accuracy of sonographer findings was assessed by constructing 2x2 tables. Results: Radiologist and sonographer’s interpretations were extracted for 223 DVT and 186 abdominal ultrasounds. The prevalence of DVT was 11.2%, while the prevalence of cholelithiasis and cholecystitis was 38.7% and 14.0%, respectively. There was 100% agreement between sonographers and radiologists for DVT studies. For gallbladder ultrasounds, the sensitivity for cholelithiasis was 98.6% (95% CI, 97.4-100%) and 69.2% for cholecystitis (95% CI, 61.6-75.9%) Conclusions: At our institution, it may be reasonable to disposition patients awaiting results for DVT studies based on the sonographer worksheet alone. The same cannot be said for gallbladder ultrasounds. This discrepancy is likely caused by increased complexity of criteria for diagnosis of cholecystitis and that sonographers did not know their worksheets would be used for this purpose. Future studies should be performed to evaluate EM clinician willingness to disposition patients based on sonographer findings and the potential impact this may have on length of stay for various types of ultrasounds. No, authors do not have interests to disclose

Volume

86

Issue

3

First Page

S234

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