Surgeon as Educator: Bedside Ultrasound in Hypertrophic Pyloric Stenosis

Abstract

Our institution has demonstrated the diagnostic accuracy of surgeon-performed ultrasound (US) in the diagnosis of hypertrophic pyloric stenosis (HPS). Moreover, we have also shown this modality to be accurate and reproducible through surgeon-to-surgeon instruction. The purpose of this study was to determine whether a surgical resident with experience in diagnosing HPS can teach pediatric emergency medicine (PEM) fellows, with little experience in sonography, to accurately measure the pyloric channel with bedside US. A surgical resident with experience in diagnosing HPS with US-proctored 4 emergency medicine fellows for 5 bedside US examinations each. A PEM fellow, who was blinded to the results from the radiology department US, then performed bedside US and measured the pyloric channel in patients presenting to the emergency department with HPS. Results between the radiology department and the fellows were compared using the Student t test. In total, 18 USs were performed on 17 patients. There were no false-negative or false-positive results. There was no statistical difference between the radiology department and fellow measurement when evaluating muscle width (p = 0.21, mean deviation = 0.2 mm) or channel length (p = 0.47, mean deviation = 0.6 mm). Bedside-performed US technique for measuring the pylorus length and width in patients with HPS is reproducible and accurate when taught to PEM providers. The learning curve for this technique is short.