OBSERVATIONAL STUDY
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Inter-rater agreement between trained emergency medicine residents and radiologists in the examination of gallbladder and common bile duct by ultrasonography.

STUDY OBJECTIVES: Bedside emergency ultrasonograAmerican Society of Emergency Radiologyphy is a rapid diagnostic tool in the emergency department (ED). Nevertheless, the learning curve for ultrasound (US) training in various indications has to date not been clearly defined. The aim of the present study was to assess how much a short specialized training program in hepatobiliary US might impact the skills of novice emergency medicine residents.

METHODS: This was a prospective observational study conducted at a university-affiliated ED from May 2014 to January 2015. Adult patients who had right upper quadrant (RUQ) abdominal pain were included. Prior to enrolling patients, seven residents voluntarily passed a 10-h hepatobiliary US training course; they also carried out 20 hands-on US examinations. To compare the results, three board-certified radiologists performed another US examination blindly. The degree of agreement between the two groups was calculated.

RESULTS: A total of 200 individuals enrolled, among whom 106 (53%) were males and 53 (47%) were females. Mean ± SD age was 50.21 ± 22.06 years. There was a moderate to perfect level of agreement between emergency medicine residents and radiologists in terms of the presence of a gallstone (Cohen's kappa = 0.85), sonographic Murphy sign (Cohen's kappa = 0.95), gallbladder wall thickening (Cohen kappa = 0.75), and common bile duct (CBD) dilation (Cohen's kappa = 0.79).

CONCLUSION: Novice emergency medicine residents attained a moderate to perfect degree of agreement with expert radiologists in detecting gallstone presence, thick gallbladder wall, sonographic Murphy sign, and CBD dilation in standard patients, after participating in a specific US course.

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