Ultrasound scanning of the acute abdomen by surgeons in training

Ultrasound is widely used in the investigation of abdominal symptoms. Its increasing popularity may lead to pressure on radiological services, diagnostic delay and prolonged hospital stay. Immediate imaging performed by radiologists can contribute useful information in acute emergencies. This study assessed the accuracy and value of abdominal ultrasonography when carried out by admitting surgeons. Three surgical registrars were first instructed for two half days by a consultant radiologist. Patients with acute symptoms were scanned at the time of initial presentation using an Aloka SSD-620 scanner with 3.5 and 5 MHz probes. A total of 205 scans was performed--124 of the upper and 81 of the lower abdomen. Immediate ultrasound provided information that contributed to the establishment or refutal of a diagnosis in 138 patients (67.3%), predominantly by confirming or excluding hepatobiliary disease, tubo-ovarian pathology or aortic aneurysms and in blunt abdominal trauma. The diagnosis was altered in a small proportion (7.8%). Scanning proved unhelpful in 62 patients and misleading in five. Findings concurred with those of a radiologist in 86% of the 139 patients subsequently scanned. Abdominal ultrasound is a useful tool in the hands of surgeons dealing with emergencies and may occasionally provide vital information. If access to radiological facilities is delayed, ultrasound by the admitting surgeon could lead to improved patient management and cost savings.