RESUMO
PURPOSE: To analyze prospectively abdominal ultrasound in an emergency department (ED) with special emphasis on different routes of obtaining radiology service, reasons for consultation and ordering diagnosis, and to identify strategies for realizing cost savings. MATERIALS AND METHODS: Over a three-month period, the course of events of 295 patients, who entered the ED and underwent on-call sonography, was recorded from the initial presentation to the commencement of treatment, and the results were subsequently evaluated. RESULTS: Of all patients sonographically examined in the ED, 60 % had no prior contact to ambulatory medical services (self-referred, S), 15 % had been sent by a physician (physician-referred, P), and 25 % were inpatients. The most frequent reason for consultation was acute abdominal pain in self-referred patients (70 %) and blunt abdominal trauma in physician-referred patients (70 %). Sonography for acute abdominal pain was considered indicated by the examining radiologist prior to the examination in 90 % (P) and 70 % (S). Sonography contributed to the diagnosis in 44 % (P) and 22 % (S). Patients had to be hospitalized in 80 % (P) and 40 % (S), and needed immediate treatment in 78 % (P) and 43 % (S). Sonography after blunt abdominal trauma was considered appropriate in 90 % (P) and 65 % (S). Diagnostic information was obtained in 90 % (P) and 88 % (S), and therapeutic interventions were required in 10 % (P) and 0 % (S). The admission rate was 97 % (P) and 29 % (S), respectively. CONCLUSIONS: In the ED, sonography was performed with significantly lower clinical effectiveness on self-referred than on physician-referred patients. Substantial cost-savings could be achieved by more selective use of abdominal sonography for self-referred patients.
