Learning curve of emergency physicians using emergency bedside sonography for symptomatic first-trimester pregnancy.

OBJECTIVE: The purpose of this study was to prospectively assess the learning curve of emergency physician training in emergency bedside sonography (EBS) for first-trimester pregnancy complications.

METHODS: This was a prospective study at an urban academic emergency department from August 1999 through July 2006. Patients with first-trimester vaginal bleeding or pain underwent EBS followed by pelvic sonography (PS) by the Department of Radiology. Results of EBS were compared with those of PS using a predesigned standardized data sheet.

RESULTS: A total of 670 patients underwent EBS for first-trimester pregnancy complications by 1 of 25 physicians who would go on to perform at least 25 examinations. The sensitivity and specificity of EBS for an intrauterine pregnancy increased from 80% (95% confidence interval [CI], 71%-87%) and 86% (95% CI, 76%-93%), respectively, for a physician's first 10 examinations to 100% (95% CI, 73%-100%) and 100% (95% CI, 63%-100%) for those performed after 40 examinations. Likewise, the sensitivity and specificity for an adnexal mass or ectopic pregnancy changed from 43% (95% CI, 28%-64%) and 94% (95% CI, 89%-97%) to 75% (95% CI, 22%-99%) and 89% (95% CI, 65%-98%), whereas the sensitivity and specificity for a molar pregnancy changed from 71% (95% CI, 30%-95%) and 98% (95% CI, 94%-99%) to 100% (95% CI, 20%-100%) and 100% (95% CI, 81%-100%). Although detection of an intrauterine or a molar pregnancy improved with training, even with experience including 40 examinations, the sensitivity of EBS for an adnexal mass or ectopic pregnancy was less than 90%.

CONCLUSIONS: There is an appreciable learning curve among physicians learning to perform EBS for first-trimester pregnancy complications that persists past 40 examinations.