ED screening to identify abdominal aortic aneurysms in asymptomatic geriatric patients

Although more than 5% of the geriatric male population is thought to have an abdominal aortic aneurysm, no study has evaluated the ability of ED physician sonographers to screen for this condition. The purpose of this study was to evaluate whether a screening program to sonographically identify abdominal aortic aneurysms would result in increased identification of this potentially lethal disease. This prospective clinical study used a convenience sample and was performed in a community teaching hospital ED. Hemodynamically stable male patients > or = 65 years of age presenting for reasons other than back, flank, or abdominal pain were eligible. After obtaining informed consent, patients underwent bedside ultrasound of the abdominal aorta by EPs. All participating physician sonographers met SAEM credentialing recommendations for performing sonography. The maximal transverse diameter of the aorta was measured at each of three locations: proximal, mid, and distal aorta. All patients with aortic diameters > or = 3.0 cm were confirmed by formal ultrasound in the radiology department. Over a 12-month period, 103 subjects were enrolled in the study. ED physician sonographers identified eight patients with abdominal aortic diameters > or = 3.0 cm. Abdominal aortic aneurysm was confirmed in 6 of 8 subjects, yielding a positive predictive value of 75%. An EP sonographic screening program can identify abdominal aortic aneurysms in asymptomatic men older than 65 years of age.