Kamil KOKULU, Ekrem Taha SERT, Hüseyin MUTLU

Acil Hekimlerinin Yatakbaşı Ultrasonografi Kullanımlarının Değerlendirilmesi

Amaç: Acil servislerde yatakbaşı ultrasonografi (US) teşhis ve tedavinin kolaylaştırılması için sık kullanılan bir araçtır. Çalışmamızın birincil amacı, acil hekimlerinin yatak başı US kullanım özelliklerini değerlendirmektir. İkincil amacımız ise, yatak başı US’nin düzenli uygulanmasını etkileyen faktörleri analiz etmektir. Gereç ve Yöntemler: Çalışmamız, acil servislerde çalışan hekimler ile gerçekleştirilen tanımlayıcı kesitsel bir anket çalışmasıdır. Çalışma, 15 maddelik bir anket ile 2020 yılında gerçekleştirildi ve sonuçlar Statistical Package for Social Sciences programı ile analiz edildi. Bulgular: 48 farklı hastanenin acil servislerinde görev yapan 965 doktora gönderilen anketten tam doldurulan 684 (%71.5)’ü çalışmaya alındı. Çalışmaya dahil edilen hastanelerin acil servislerinde en az bir adet US cihazı vardı ve bunların % 82’si üç propluydu. Acil hekimler- inden 152 (%22.2)’sinin hiç US kullanmadığı, 532 (% 77.8)’sinin ise nadiren de olsa düzenli US kullandığı görüldü. Acil serviste US’nin en sık kullanım yeri FAST (Focused assessment with sonography in trauma), ardından ise prosedürel işlemlerdi (sırasıyla 432 [%63.2] ve 308 [%45]). Düzenli yatakbaşı US kullanmayan doktorların %33.3’ünün (n=96) eğitim eksikliği nedeniyle US kullanmadığı görüldü. Ayrıca acil servis hekimlerinin US eğitimine olan ilgisi 7±3 puan olarak ölçüldü. Yatakbaşı US‘nin sık kullanımı ile ilişkili durumların: cinsiyet, US eğiti- minin asistanlık eğitimi sürecinde alınmış olması ve acil kliniğinde US makinesinin mevcut olma süresi olduğu görüldü. Sonuç: Bu çalışma, acil hekimlerinin yatakbaşı US kullanımına ilgilerinin yüksek olduğunu gösterdi. US kullanımının önündeki en büyük engel, yetersiz görülen eğitimdi. Bu sebeple acil servis hekimlerine düzenli olarak US eğitimi verilmeli ve eğitim almayanlar eğitime teşvik edilmelidir.

Evaluation of Bedside Ultrasonography Use of Emergency Physicians

Aim: Bedside ultrasonography (US) is a frequently used tool to facilitate diagnosis and treatment in emergency departments (EDs). The primary aim of our study was to evaluate the characteristics of emergency physicians’ use of bedside US. Our secondary aim was to analyze factors affecting the regular use of bedside US. Material and Methods: This was a descriptive cross-sectional survey study conducted with physicians working in EDs. The study was carried out using a 15-item questionnaire in 2020, and the results were analyzed with the Statistical Package for the Social Sciences software. Results: The questionnaire was sent to 965 physicians working in the EDs of 48 different hospitals, and the data of 684 (71.5%) that responded to all items in the questionnaire were included in the study. The EDs of the hospitals included in the study had at least one US device, and 82% of them were equipped with three probes. It was observed that 152 (22.2%) of the emergency physicians did not use US at all, and 532 (77.8%) used US regularly, albeit rarely. The most common area of use for US in the ED was focused assessment with sonography in trauma, followed by procedural guidance [432 (63.2%) and 308 (45%), respectively]. Of the physicians who did not use bedside US regularly, 33.3% (n=96) stated that they did not use it due to their lack of training. In addition, the interest of emergency physicians in US education was measured as 7±3 points. It was observed that the conditions associated with frequent use of bedside US were gender, inclusion of US training during residency, and duration of the availability of an US machine in the emergency clinic. Conclusion: This study showed that emergency physicians had a high interest in using bedside US. The greatest obstacle to the use of US was insufficient training. Therefore, emergency physicians should be offered regular US training programs sand those that have not received US training should be encouraged to participate in such programs.

PDF

___

1. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med 2011;364(8):749-757.
2. Ultrasound Guidelines: Emergency, Point-of-Care and Clinical Ultrasound Guidelines in Medicine. Ann Emerg Med 2017;69(5):e27-e54.
3. Bobbia X, Zieleskiewicz L, Pradeilles C, Hudson C, Muller L, Claret FG, Leone M, de La Coussaye JE, Winfocus France Group. The clinical impact and prevalence of emergency point- of-care ultrasound: A prospective multicenter study. Anaesth Crit Care Pain Med 2017;36(6):383-389.
4. Lapostolle F, Deltour S, Petrovic T. Ultrasound in emergency medicine. Ann Cardiol Angeiol (Paris) 2015;64(6):446-448.
5. Kozaci N, Avci M. Acil serviste odaklanmış kas-iskelet ultrasonografisi ile kas yaralanmalarının tanısı: Bir olgu sunumu. Anatolian J of Emerg Med 2020;3(2):58-61.
6. Değirmenci S. Role of Ultrasound Simulators in the Training for Focused Assessment with Sonography for Trauma (FAST). Ulus Travma Acil Cerrahi Derg Published online 2020. doi:10.14744/tjtes.2020.73626
7. Whitson MR, Mayo PH. Ultrasonography in the emergency department. Crit Care 2016;20(1):227.
8. Bobbia X, Abou-Badra M, Hansel N, Pes P, Petrovic T, Claret PG, Lefrant JY, La Coussaye JE, Winfocus France Group. Changes in the availability of bedside ultrasound practice in emergency rooms and prehospital settings in France. Anaesth Crit Care Pain Med 2018;37(3):201-205.
9. Sofia S, Angelini F, Cianci V, Copetti R, Farina R, Scuderi M. Diffusion and practice of ultrasound in emergency medicine departments in Italy. J Ultrasound 2009;12(3):112-117.
10. Nagaraj G, Chu M, Dinh M. Emergency clinician performed ultrasound: Availability, uses and credentialing in Australian emergency departments. Emerg Med Australas 2010;22(4):296- 300.
11. Henwood PC, Mackenzie DC, Rempell JS, Douglass E, Dukundane D, Liteplo AS, Leo MM, Murray AF, Vaillancourt S, Dean AJ, Lewiss RE, Rulisa S, Krebs E, Rao AKR, Rudakemwa E, Rusanganwa V, Kyanmanywa P, Noble VE. Intensive point- of-care ultrasound training with long-term follow-up in a cohort of Rwandan physicians. Trop Med Int Health 2016;21(12):1531- 1538.
12. Bell G, Wachira B, Denning G. A pilot training program for point- of-care ultrasound in Kenya. Afr J Emerg Med 2016;6(3):132- 137.
13. Leschyna M, Hatam E, Britton S, Myslik F, Thompson D, Sedran R, VanAarsen K, Detombe S. Current state of point-of- care ultrasound usage in Canadian Emergency Departments. Cureus 2019;11(3):e4246.
14. Sanders JL, Noble VE, Raja AS, Sullivan AF, Camargo CA. Access to and use of point-of-care ultrasound in the emergency department. West J Emerg Med 2015;16(5):747-752.
15. Bobbia X, Pradeilles C, Claret PG, Soullier C, Wagner P, Bodin Y, Roger C, Cayla G, Muller L, de La Coussaye JE. Does physician experience influence the interpretability of focused echocardiography images performed by a pocket device? Scand J Trauma Resusc Emerg Med 2015;23(1):52.
16. Filler L, Orosco D, Rigdon D, Mitchell C, Price J, Lotz S, Stowell JR. Evaluation of a novel curriculum on point-of-care ultrasound competency and confidence. Emerg Radiol 2020;27(1):37-40.
17. Koratala A, Segal MS, Kazory A. Integrating point-of-care ultrasonography into nephrology fellowship training: A model curriculum. Am J Kidney Dis 2019;74(1):1-5.
18. Amini R, Adhikari S, Fiorello A. Ultrasound competency assessment in emergency medicine residency programs. Acad Emerg Med 2014;21(7):799-801.
19. Arntfield RT, Millington SJ, Ainsworth CD, Arora R, Boyd J, Finlayson G, Gallagher W, Gebhardt C, Goffi A, Hockman E, Kirkpatrick A, McDermid R, Waechter J, Wong N, Zavalkoff S, Beaulieu Y. Canadian recommendations for critical care ultrasound training and competency. Can Respir J 2014;21(6):341-345.
20. Michels G, Zinke H, Möckel M, Hempel D, Busche C, Janssens U, Kluge S, Riessen R, Buerke M, Kelm M, von Bardeleben RS, Knebel F, Busch HJ. Recommendations for education in ultrasound in medical intensive care and emergency medicine: Position paper of DGIIN, DEGUM and DGK. Med Klin Intensivmed Notfmed 2017;112(4):314-319.
21. Lesage B, Martinez M, Lefebvre T, Cavalli P, Cailasson L, Leger M, d’Arras AC, Boyer A, Redjaline A, Viallon A. Practice of emergency point-of-care ultrasound in a French emergency medicine network. Ann Fr Med Urgence 2019;9(1):33-40.