Abstract
BackgroundTrauma is a major cause of death among the working population. Many countries have now adopted a structured approach to trauma management in which ultrasound is used as a primary evaluation tool. While its use has direct therapeutic benefits, many artifacts and pitfalls are inherent to the technique. Knowledge of the most frequently encountered pitfalls in practice could thus help reduce the risk of error and lead to more accurate trauma assessments.ObjectiveThis study evaluates a potential pitfall caused by seminal vesicles during focused assessment with sonography for trauma examinations of the male pelvis performed by an emergency physician with experience in point-of-care ultrasound.MethodsWe took five static and five dynamic (3-s loops) transverse ultrasound images of the pelvis in five healthy males. The images and videos were then incorporated into an online survey and emailed through the World Interactive Network Focused On Critical UltraSound (WINFOCUS) in France and the Ultrasound and Emergency Medicine (UEM) Organization in Belgium. A questionnaire asked anonymous participants to assess the presence of free fluid in the static and dynamic images and to share information about their training and experience in point-of-care ultrasound. To validate the static and dynamic images, the survey was sent to three external radiologists for independent verification.ResultsA total of 191 individuals responded fully or partially to the survey, 114 of whom completed it. Among the 114 participants who completed the survey, the misinterpretation rate was 0.55 (95CI 0.51–0.60) for all static and dynamic ultrasound transverse pelvic views. The misinterpretation rate was 0.61 (95CI 0.55–0.66) and 0.50 (95CI 0.45–0.55) for static and dynamic ultrasound transverse pelvic views, respectively. The three external radiologists answered the questionnaire correctly without misinterpreting the survey ultrasound views.ConclusionsSeminal vesicles are a potential pitfall when interpreting transverse ultrasound images of the male pelvis in the context of point-of-care ultrasound.
Highlights
Trauma is a major cause of death among the working population
The images and videos were incorporated into an online survey and emailed through the World Interactive Network Focused On Critical UltraSound (WINFOCUS) in France and the Ultrasound and Emergency Medicine (UEM) Organization in Belgium
A questionnaire asked anonymous participants to assess the presence of free fluid in the static and dynamic images and to share information about their training and experience in point-of-care ultrasound
Summary
Many countries have adopted a structured approach to trauma management in which ultrasound is used as a primary evaluation tool. Injuries are the leading cause of death for people aged between 1 and 44 years [1]. A structured approached to trauma management is followed in many countries using the Advanced Trauma Life Support (ATLS) protocol for the initial assessment of patients. Surgery of Trauma guidelines all support the use of ultrasound during the assessment of severe trauma [2,3,4]. Clinical ultrasound use in emergency departments has increased considerably since its introduction more than 30 years ago [5]. Bedside ultrasounds allow the rapid evaluation of patients to determine the presence of free fluid in the peritoneum or pericardium. Focused assessment with sonography for trauma (FAST) is a point-of-care ultrasound (POCUS) examination of four sites: Morrison’s pouch between the liver and right kidney, the splenorenal recess, the pelvic area, and the pericardial space [6]
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