Öz
Amaç: Acil tıp hastalara hızlı ve doğru tanılar koymayı gerektiren yüksek riskli bir alandır. Son yıllarda ultrasonografi acil tıpta teşhis ve tedavi süreçlerini hızlandıran kritik bir araç haline gelmiştir. Bu çalışma, acil tıp doktorlarının yatak başı ultrasonografi (YBU) yetkinliklerini değerlendirmeyi, eğitim geçmişlerini, cihaz erişimlerini ve Türkiye’deki acil servislerde karşılaştıkları zorlukları incelemeyi amaçlamıştır.
Materyal ve Metod: Türkiye’deki çeşitli hastanelerden 430 acil tıp doktoru ile kesitsel bir anket çalışması gerçekleştirildi. Veriler; demografik bilgileri, YBU eğitimini, cihaz kullanım alışkanlıklarını, altı alanda (FAST, kardiyak, abdominal, torasik, vasküler, kas-iskelet) kendi yetkinlik düzeyi değerlendirmelerini (1-5 Likert ölçeği) ve karşılaşılan engelleri içermektedir. SPSS 26.0 kullanılarak istatistiksel analizler (Mann-Whitney U, Kruskal-Wallis, Spearman korelasyonu, Ki-kare, çoklu regresyon) yapıldı ve anlamlılık düzeyi p<0,05 olarak belirlendi.
Bulgular: Katılımcıların %58,1’i (n=250) YBU eğitimi almış olup, en yaygın eğitimler FAST (Focused Assessment with Sonography for Trauma) (%62,8) ve kardiyak odaklı ultrasonografi (FOCUS) (%51,2) alanlarında idi. FAST alanındaki yetkinlik ortalaması en yüksekti (M=3,62, SD=1,22). Eğitim alan doktorlar, kardiyak (p=0,012) ve FAST (p=0,033) alanlarında eğitimsizlere göre daha üstün yetkinlik gösterdi. Hekimin deneyimi, aylık YBU uyguladığı hasta sayısıyla güçlü bir şekilde ilişkiliydi (r=0,71, p<0,001) ve FAST alanındaki yetkinlik puanlarını etkiledi (r=0,59, p<0,001). Cihaz sık kullanımı abdominal alanda yetkinliği artırdı (p=0,008). Çoklu regresyon, FAST uygulama yetkinliğinde eğitimi (β=0,42, p=0,015) ve deneyimi (β=0,38, p=0,022) ana belirleyiciler olarak gösterdi (R²=0,51). Cihaz yetersizliği (%51,2) ve teknik bilgi eksikliği (%41,9) ise başlıca engellerdi.
Sonuç: YBU yetkinliği, eğitim ve deneyimle önemli ölçüde artarken, ekipman ve bilgi eksiklikleri tarafından kısıtlanmaktadır. Yapılandırılmış eğitim ve altyapı iyileştirmeleri, acil bakımda YBU’yu optimize etmek ve kullanımını arttırmak için gereklidir.
Anahtar Kelimeler
Kaynakça
- 1. Whitson MR, Mayo PH. Ultrasonography in the emergency department. Crit Care. 2016;20(1):227.
- 2. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749-57.
- 3. Henwood PC, Mackenzie DC, Liteplo AS, Rempell JS, Murray AF, Leo MM, et al. Point-of-care ultrasound use, accuracy, and impact on clinical decision making in Rwanda hospitals. J Ultrasound Med. 2017;36(6):1189-94.
- 4. Amini R, Adhikari S, Fiorello A. Ultrasound competency assessment in emergency medicine residency programs. Acad Emerg Med. 2014;21(7):799-801.
- 5. American College of Emergency Physicians. Ultrasound guidelines: Emergency, point-of-care, and clinical ultrasound guidelines in medicine. Ann Emerg Med. 2016;68(1):e7-e28.
- 6. Atkinson P, Bowra J, Lambert M, Lamprecht H, Noble V, Jarman B. International Federation for Emergency Medicine point of care ultrasound curriculum. CJEM. 2015;17(2):161-70.
- 7. Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: The first Sonography Outcomes Assessment Program trial. Ann Emerg Med. 2006;48(3):227-35.
- 8. Sanders JL, Noble VE, Raja AS, Sullivan AF, Camargo CA. Access to and use of point-of-care ultrasound in the emer-gency department. West J Emerg Med. 2015;16(5):747-52.
- 9. Kokulu K, Sert ET, Mutlu H. Evaluation of bedside ultrasonog-raphy use of emergency physicians. Batı Karadeniz Tıp Dergi-si. 2021;5(2):182-7.
- 10. Gülünay B, Günsoy E. Ultrasonography use in emergency health services. Journal of Ankara University Faculty of Me-dicine. 2022;75(1):1-7.
- 11. Gaspari RJ, Dickman E, Blehar D. Learning curve of bedside ultrasound of the gallbladder. J Emerg Med. 2009;37(1):51-6.
- 12. Nagaraj G, Chu M, Dinh M. Emergency clinician performed ultrasound: availability, uses and credentialing in Australian emergency departments. Emerg Med Australas. 2010;22(4):296-300.
- 13. Girişgin SA, Koyuncu F, Ergin M, Yıldırım C, Cander B, Fowler J, et al. Interperation of “Basic Ultrasonografy Course” in Emergency Medicine. J Acad Emerg Med 2011;10(1):46-49. 14. Değirmenci S, Kara H, Kayış SA, Ak A. Role of ultrasound simulators in the training for Focused Assessment with So-nography for Trauma (FAST). Turk J Trauma Emerg Surg 2021;27(3):303-309.
Öz
Background: Emergency medicine is a high-risk field that requires rapid and accurate diagnoses of pati-ents. In recent years, ultrasonography has become a critical tool that accelerates the diagnostic and treatment processes in emergency medicine. This study aimed to evaluate the competency of emer-gency physicians in point-of-care ultrasound (POCUS), examining their training backgrounds, device accessibility, and challenges encountered in emergency departments (EDs) across Turkey.
Materials and Methods: A cross-sectional survey was conducted with 430 emergency physicians from various hospitals in Turkey. The collected data included demographic information, POCUS training, device usage habits, self-assessment of competency level (on a 1–5 Likert scale) in six domains (FAST, cardiac, abdominal, thoracic, vascular, musculoskeletal), and encountered barriers. Statistical analyses were performed using SPSS 26.0 (Mann-Whitney U, Kruskal-Wallis, Spearman correlation, Chi-square, and multiple regression), with a significance level set at p<0.05.
Results: 58.1% of participants (n=250) had received training in Point-of-Care Ultrasound (POCUS), with the most common areas of training being FAST (Focused Assessment with Sonography for Trauma) (62.8%) and cardiac-focused ultrasound (FOCUS) (51.2%). The average competency in the FAST area was the highest (M=3.62, SD=1.22). Physicians who received training demonstrated superior competency in cardiac (p=0.012) and FAST (p=0.033) assessments compared to those without training. The physician's experience was strongly correlated with the number of patients undergoing POCUS per month (r=0.71, p<0.001) and affected competency scores in the FAST area (r=0.59, p<0.001). Frequent use of the devi-ce increased competency in the abdominal area (p=0.008). Multiple regression analysis indicated that training (β=0.42, p=0.015) and experience (β=0.38, p=0.022) were the main determinants of compe-tency in the FAST area (R²=0.51). Device inadequacy (51.2%) and lack of technical knowledge (41.9%) were identified as major barriers.
Conclusions: POCUS competency significantly improves with training and experience but is constrained by equipment shortages and knowledge deficits. Structured training programs and infrastructure en-hancements are essential to optimize POCUS utilization and improve emergency care delivery.
Anahtar Kelimeler
Kaynakça
- 1. Whitson MR, Mayo PH. Ultrasonography in the emergency department. Crit Care. 2016;20(1):227.
- 2. Moore CL, Copel JA. Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749-57.
- 3. Henwood PC, Mackenzie DC, Liteplo AS, Rempell JS, Murray AF, Leo MM, et al. Point-of-care ultrasound use, accuracy, and impact on clinical decision making in Rwanda hospitals. J Ultrasound Med. 2017;36(6):1189-94.
- 4. Amini R, Adhikari S, Fiorello A. Ultrasound competency assessment in emergency medicine residency programs. Acad Emerg Med. 2014;21(7):799-801.
- 5. American College of Emergency Physicians. Ultrasound guidelines: Emergency, point-of-care, and clinical ultrasound guidelines in medicine. Ann Emerg Med. 2016;68(1):e7-e28.
- 6. Atkinson P, Bowra J, Lambert M, Lamprecht H, Noble V, Jarman B. International Federation for Emergency Medicine point of care ultrasound curriculum. CJEM. 2015;17(2):161-70.
- 7. Melniker LA, Leibner E, McKenney MG, Lopez P, Briggs WM, Mancuso CA. Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: The first Sonography Outcomes Assessment Program trial. Ann Emerg Med. 2006;48(3):227-35.
- 8. Sanders JL, Noble VE, Raja AS, Sullivan AF, Camargo CA. Access to and use of point-of-care ultrasound in the emer-gency department. West J Emerg Med. 2015;16(5):747-52.
- 9. Kokulu K, Sert ET, Mutlu H. Evaluation of bedside ultrasonog-raphy use of emergency physicians. Batı Karadeniz Tıp Dergi-si. 2021;5(2):182-7.
- 10. Gülünay B, Günsoy E. Ultrasonography use in emergency health services. Journal of Ankara University Faculty of Me-dicine. 2022;75(1):1-7.
- 11. Gaspari RJ, Dickman E, Blehar D. Learning curve of bedside ultrasound of the gallbladder. J Emerg Med. 2009;37(1):51-6.
- 12. Nagaraj G, Chu M, Dinh M. Emergency clinician performed ultrasound: availability, uses and credentialing in Australian emergency departments. Emerg Med Australas. 2010;22(4):296-300.
- 13. Girişgin SA, Koyuncu F, Ergin M, Yıldırım C, Cander B, Fowler J, et al. Interperation of “Basic Ultrasonografy Course” in Emergency Medicine. J Acad Emerg Med 2011;10(1):46-49. 14. Değirmenci S, Kara H, Kayış SA, Ak A. Role of ultrasound simulators in the training for Focused Assessment with So-nography for Trauma (FAST). Turk J Trauma Emerg Surg 2021;27(3):303-309.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Acil Tıp |
| Bölüm | Araştırma Makalesi |
| Yazarlar | |
| Erken Görünüm Tarihi | 30 Mayıs 2025 |
| Yayımlanma Tarihi | 27 Haziran 2025 |
| Gönderilme Tarihi | 26 Şubat 2025 |
| Kabul Tarihi | 9 Mayıs 2025 |
| Yayımlandığı Sayı | Yıl 2025 Cilt: 22 Sayı: 2 |
Harran Üniversitesi Tıp Fakültesi Dergisi / Journal of Harran University Medical Faculty