A score-based method to improve the quality of emergency gynaecological ultrasound examination

Abstract 

Objectives

The quality of ultrasound (US) examination in the setting of a gynaecological emergency consultation is variable. Our aims were to develop and evaluate the feasibility of an image-based scoring method for the evaluation of standardised gynaecological images in this context.

Study design

Ultrasound images of the uterus (2 planes), ovaries (1 plane of each side) and Morrison's pouch were obtained by specialist registrars as part of their assessment of gynaecological emergencies during a three-month period. Twenty images of each of these 5 planes were randomly selected and anonymised. These 100 images were analysed by two reviewers. Each image was scored according to 23 criteria yielding a maximum score of 23 points for the entire ultrasound examination. Training was then offered with special emphasis on quality criteria. Following training, another set of 100 images obtained by the same specialist registrars was scored. Scores before and after training were compared. Inter- and intra-reviewer reproducibility were analysed using intra-class correlation, adjusted Kappa and Bland–Altman plot.

Results

The mean (±SD) scores were 10.22(±2.75) and 16.1(±3.35) before and after theoretical training respectively (p<10⁻⁴). The intra-class correlation coefficient and the mean difference in score were 0.973 [0.957;0.990] and 0.02 [−1.98;1.94], and 0.952 [0.894;1] and −0.1 [−2.44;2.24] for inter- and intra-reviewer reproducibility respectively. Kappa values were above 0.8 for all but 3 criteria.

Conclusion

A quality control policy for gynaecological emergencies based on image scoring is feasible and allows for good inter- and intra-reviewer reproducibility. A policy of this nature is likely to improve the quality of emergency gynaecological ultrasound examination.

Keywords: Ultrasound, Emergency, Quality, Gynaecology, Resident