BackgroundPhysicians often cite time as a limitation to performing a focused cardiac ultrasound (FoCUS) exam. The primary outcome of this study was to determine the amount of time to complete a quality FoCUS exam. Secondary outcomes evaluated time differences between different training levels. MethodsFoCUS exams were performed by emergency medicine (EM) residents, EM ultrasound (US) fellows, US fellowship-trained EM attendings, and EM attendings credentialed in US. Time to complete a FoCUS exam is the time difference between the first and final images acquired during the exam. Chi-square, t-tests, analysis of variance, and linear regression were performed to evaluate the data obtained in the study. ResultsSix-hundred FoCUS exams were included in the study. Of these, 34 % had 3 views and 55.5 % had 4 views. Most studies (78.9 %) had a quality rating of 4 or 5. The average time for all groups to complete a FoCUS was 3.4 min. Residents took 3.8 min while attendings took 3.1 min. On average, PGY1 residents took 4.6 min, PGY2 residents took 4.0 min, and PGY3 residents took 2.8 min (p ≤0.0001). ConclusionsOur study shows EM physicians take approximately 3.4 min to complete a quality FoCUS exam and residents took 45 s longer compared to attendings. For resident physicians, the amount of time it takes to complete a quality FoCUS exam decreases over the course of residency training. Our findings suggest the amount of time to complete a quality FoCUS exam should not be a limitation to perform a FoCUS exam.

Study hypothesisPoint-of-care ultrasound (PoCUS) can be used as a non-invasive and radiation free adjunct in the triage of patients with clavicle injuries. However, the diagnostic accuracy of PoCUS performed by non-radiologists for this purpose is not yet sufficiently established. MethodsA multicentre, prospective cohort study was conducted in 8 emergency departments (EDs) to establish the diagnostic accuracy of PoCUS of the clavicle in patients ≥4 years of age who presented with a clavicle injury. PoCUS was performed by trained emergency physicians, and results were compared with X-ray outcomes (gold standard). ResultsA total of 167 patients were included, of which 127 (76 %) patients had a fracture on X-ray, and 121 (72 %) on PoCUS. PoCUS of the clavicle had a sensitivity of 93 % (95 %CI 87–97 %), a specificity of 93 % (95 %CI 80–98 %), a negative likelihood ratio of 0.09 (95 %CI 0.04–0.14), and a positive likelihood ratio of 12.39 (95 %CI 4.17–36.82) for the presence of a clavicle fracture. Stratified based on age, specificity of PoCUS was lower in children compared to adults, whereas sensitivity was not affected. The agreement between X-ray and PoCUS for fracture displacement was substantial (κ = 0.771). ConclusionsPoCUS of the clavicle is a useful adjunct in the triage of patients with clavicle injuries and can help to distinguish which patients need further diagnostic workup. Trial registration numberNetherlands Trial Register, registration code: NL9236.