Systematic Sonography Looking for Occult Wounds: accuracy of an abdominal ultrasound adjunct in penetrating trauma.

BACKGROUND: Systematic Sonography Looking for Occult Wounds (SSLOW) in trauma is a novel technique for the evaluation of intra-abdominal wounds in penetrating trauma. No data exist regarding the effectiveness. The objective of this study was to evaluate the accuracy of the SSLOW exam. METHODS: This is a prospective collected case series conducted over a period of 10 months and took place at the Accident and Emergency Department (A&E) of the Georgetown Public Hospital Corporation (GPHC). The study enrolled patients presenting to the A&E who were 16 years old or greater with penetrating abdominal trauma. All patients with penetrating trauma received an E-FAST examination. If the E-FAST examination was negative, a SSLOW examination was completed. The sonographer evaluated for free fluid collection between the loops of bowel. The results of the SSLOW were compared to usual care (surgery consult, serial abdominal and E-FAST exams, laparotomy, and 7-day follow-up) and then categorized into four groups: true positive, false positive, true negative, and false negative. These results lead to four categorical values. From these results, sensitivity, specificity, positive predictive value, negative predictive value, and likelihood ratios were calculated. RESULTS: There were 5 (12%) true positives, 1 (2%) false positive, 37 (86%) true negatives, and zero (0%) false negative. The SSLOW was 100% sensitive (95% CI 5-100%) and 97% specificity (95% CI 74-96%). There was an 80% positive predictive value (95% CI 1.0-64% 95% CI) and 100% negative predictive value (95% CI 88-100%). The positive likelihood ratio was 8.4 (95% CI 3.69-19.1) and negative likelihood ratio was 0. CONCLUSION: The SSLOW examination may be a useful tool in the evaluation of penetrating abdominal injuries.

Emergency Ultrasound Training Program in Guyana: Systematic Credentialing Process in a Resource-limited Setting.

Ultrasound has become an important skill for emergency physicians. Ultrasound is more crucial in resource-limited settings where diagnostic testing may not be as timely or available at all. In 2015, an emergency medicine ultrasound curriculum was implemented at Georgetown Public Hospital Corporation in Georgetown, Guyana. Implementing an ultrasound-training curriculum in Guyana had four main challenges: limited ultrasound equipment, lack of informational technology infrastructure to record and review ultrasound examinations, availability of local emergency ultrasound expertise, and competing educational needs within the curriculum. These challenges were met with creative solutions and the formation of a formalized curriculum and credentialing process. The experience of creating the program is described along with the curriculum, credentialing process, and plan for sustainability. Since implementation, every graduating resident has displayed competency on final assessment.