NDLI: Emergency medicine residents’ learning curve in diagnosing deep vein thrombosis with 3-point venous point-of-care ultrasound

Content Provider	Springer Nature : BioMed Central
Author	Kang, Soo Yeon Jo, Ik Joon Heo, Sejin Chang, Hansol Lee, Guntak Park, Jong Eun Kim, Taerim Lee, Se Uk Kim, Min Ji Yoon, Hee
Abstract	Background Many cases of deep vein thrombosis (DVT) are diagnosed in the emergency department, and abbreviated lower extremity venous point-of-care ultrasound (POCUS) has already shown an accuracy comparable to that of specialists. This study aimed to identify the learning curve necessary for emergency medicine (EM) residents to achieve expertise-level accuracy in diagnosing DVT through a 3-point lower extremity venous POCUS. Methods This prospective study was conducted at an emergency department between May 2021 and October 2022. Four EM residents underwent a one-hour POCUS training session and performed DVT assessments in participants with DVT symptoms or confirmed pulmonary embolism. POCUS was performed at three proximal lower extremity sites to evaluate the thrombi presence and vein compressibility, with results validated by specialized radiology ultrasound. Cumulative sum (CUSUM) and the Bush and Mosteller models were used to analyze the learning curve, while generalized estimating equations were used to identify factors affecting diagnostic accuracy. Results 91 POCUS scans were conducted in 49 patients, resulting in 22% DVT confirmed by specialized venous ultrasound. In the CUSUM analysis, all four EM residents attained a 90% success rate at the common femoral vein, whereas only half achieved this rate when all three sites were considered. According to Bush and Mosteller models, 13–18 cases are required to attain 90–95% diagnostic accuracy. After 10–16 cases, the examination time for each resident decreased, and a 20% increase in examiner confidence was linked to a 2.506-fold increase in the DVT diagnosis accuracy. Conclusion EM residents generally required 13–18 cases for 90–95% DVT diagnostic accuracy, but proficiency varied among individuals, particularly requiring more cases for regions outside the common femoral vein.
Related Links	https://intjem.biomedcentral.com/counter/pdf/10.1186/s12245-024-00645-x.pdf
Ending Page	9
Page Count	9
Starting Page	1
File Format	HTM / HTML
ISSN	18651380
DOI	10.1186/s12245-024-00645-x
Journal	International Journal of Emergency Medicine
Issue Number	1
Volume Number	17
Language	English
Publisher	BioMed Central
Publisher Date	2024-06-17
Access Restriction	Open
Subject Keyword	Emergency Medicine Internal Medicine Cardiology Angiology Pediatrics Deep vein thrombosis Point-of-care ultrasound Learning curve Diagnostic accuracy
Content Type	Text
Resource Type	Article
Subject	Emergency Medicine

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