{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,11,12]],"date-time":"2025-11-12T14:28:19Z","timestamp":1762957699714,"version":"3.45.0"},"reference-count":57,"publisher":"Wiley","issue":"11","license":[{"start":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T00:00:00Z","timestamp":1752192000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/501100001078","name":"Emergency Medicine Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100001078","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100005616","name":"Memorial University of Newfoundland","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100005616","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2025,11]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objectives<\/jats:title>\n                    <jats:p>We aimed to identify the most diagnostically challenging features in first\u2010trimester point\u2010of\u2010care ultrasound (FT\u2010POCUS) images. We also sought to determine the physician image review behaviors associated with increased diagnostic accuracy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a multicenter prospective cross\u2010sectional study in a convenience sample of emergency physicians in the United States and Canada. The web\u2010based intervention included 400 FT\u2010POCUS cases acquired via the transabdominal or transvaginal approach. Participants reviewed FT\u2010POCUS cases to identify pregnancy\u2010related imaging findings. We captured clickstream\u2010level data with each case encounter, including the correctness of a participant's response and physician image review behaviors.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      We enrolled 317 participants, who collectively generated 16,295 case interpretations. The most diagnostically challenging imaging findings included eccentrically located gestational sac and endometrial collection\/heterogeneous uterine material (\n                      <jats:italic>p<\/jats:italic>\n                      \u2009&lt;\u20090.001 for all comparisons). Participants who reported \u201cdefinite\u201d certainty, as opposed to \u201cprobable,\u201d demonstrated a significantly higher odds of getting the diagnosis of intrauterine pregnancy (IUP) present or absent correct (OR\u2009=\u20094.48; 95% CI 4.00, 5.01) and a lower odds of time spent reviewing cases (OR\u2009=\u20090.46; 95% CI 0.40, 0.51). Those who reviewed a higher proportion of available views per case were more likely to accurately identify a fetal heartbeat (OR\u2009=\u20091.51; 95% 1.34, 1.69), multiple IUPs (OR\u2009=\u20091.33; 95% CI 1.10, 1.61), and adnexal structures (OR\u2009=\u20091.11; 95% CI 1.04, 1.17), but less likely to correctly identify an IUP (OR\u2009=\u20090.93; 95% CI 0.88, 0.99) and endometrial fluid collection\/heterogeneous uterine material (OR\u2009=\u20090.96; 95% CI 0.92, 0.99).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Emergency physicians interpreting FT\u2010POCUS images encountered specific diagnostic challenges that may increase risks to patient safety. We found that higher diagnostic confidence correlated with greater diagnostic accuracy and efficiency. Reviewing a larger proportion of available images improved diagnostic accuracy for some findings, but not for others.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/acem.70094","type":"journal-article","created":{"date-parts":[[2025,7,11]],"date-time":"2025-07-11T08:43:31Z","timestamp":1752223411000},"page":"1224-1234","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["First Trimester Point of Care Ultrasound: Imaging Features and Review Behaviors Associated With Diagnostic Accuracy"],"prefix":"10.1111","volume":"32","author":[{"given":"Gillian","family":"Sheppard","sequence":"first","affiliation":[{"name":"Discipline of Emergency Medicine Memorial University  St. John's Newfoundland and Labrador Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1400-1413","authenticated-orcid":false,"given":"Lori","family":"Stolz","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jeremy S.","family":"Boyd","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Vanderbilt University  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5236-6598","authenticated-orcid":false,"given":"Martin","family":"Pusic","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics Boston Children's Hospital, Harvard University  Boston Massachusetts USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1175-8373","authenticated-orcid":false,"given":"Jessica","family":"Baez","sequence":"additional","affiliation":[{"name":"Discipline of Emergency Medicine Memorial University  St. John's Newfoundland and Labrador Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Patrick","family":"Minges","sequence":"additional","affiliation":[{"name":"Discipline of Emergency Medicine Memorial University  St. John's Newfoundland and Labrador Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Matthew","family":"Swarm","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Vanderbilt University  Nashville Tennessee USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Megan","family":"Hilbert","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Pittsburgh Medical Center  Pittsburgh Pennsylvania USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Marisa","family":"O'Brien","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Katie","family":"Harris","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine University of Cincinnati  Cincinnati Ohio USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9696-1329","authenticated-orcid":false,"given":"Catherine","family":"Varner","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Mt. Sinai Hospital, University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Constance","family":"LeBlanc","sequence":"additional","affiliation":[{"name":"Department of Emergency Medicine Dalhousie University  Halifax Nova Scotia Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kathy","family":"Boutis","sequence":"additional","affiliation":[{"name":"Division of Pediatric Emergency Medicine, Department of Pediatrics Hospital for Sick Children and University of Toronto  Toronto Ontario Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2025,7,11]]},"reference":[{"key":"e_1_2_12_2_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2023.2639"},{"key":"e_1_2_12_3_1","doi-asserted-by":"publisher","DOI":"10.1097\/GRF.0b013e31802f17fc"},{"key":"e_1_2_12_4_1","doi-asserted-by":"publisher","DOI":"10.1017\/S1481803500011416"},{"key":"e_1_2_12_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(21)00682-6"},{"key":"e_1_2_12_6_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2019.03.025"},{"key":"e_1_2_12_7_1","doi-asserted-by":"publisher","DOI":"10.1017\/cem.2017.44"},{"key":"e_1_2_12_8_1","doi-asserted-by":"publisher","DOI":"10.1002\/aet2.10817"},{"key":"e_1_2_12_9_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajum.12317"},{"key":"e_1_2_12_10_1","unstructured":"Fronti\u00e8res MS \u201cTransforming Clinical Care at the Patient's Bedside With Point\u2010of\u2010Care Ultrasound \u201dhttps:\/\/msf\u2010transformation.org\/news\/pocus\u20102\/."},{"key":"e_1_2_12_11_1","doi-asserted-by":"publisher","DOI":"10.5811\/westjem.2017.7.34668"},{"key":"e_1_2_12_12_1","unstructured":"Royal College of Emergency Medicine \u201cUltrasound Education & Training \u201dhttps:\/\/rcem.ac.uk\/ultrasound\/."},{"key":"e_1_2_12_13_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2016.07.030"},{"key":"e_1_2_12_14_1","doi-asserted-by":"publisher","DOI":"10.1002\/ajum.12355"},{"key":"e_1_2_12_15_1","doi-asserted-by":"publisher","DOI":"10.3346\/jkms.2021.36.e141"},{"key":"e_1_2_12_16_1","doi-asserted-by":"publisher","DOI":"10.1002\/aet2.10375"},{"key":"e_1_2_12_17_1","doi-asserted-by":"publisher","DOI":"10.1002\/jum.15857"},{"key":"e_1_2_12_18_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2025.01.005"},{"key":"e_1_2_12_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/ACM.0000000000001234"},{"key":"e_1_2_12_20_1","article-title":"Image Interpretation: Learning Analystics Based Education Opportunities","volume":"5","author":"Thau E.","year":"2021","journal-title":"Academic Emergency Medicine Education and Training"},{"key":"e_1_2_12_21_1","doi-asserted-by":"publisher","DOI":"10.1097\/PEC.0000000000002396"},{"key":"e_1_2_12_22_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12245-025-00819-1"},{"key":"e_1_2_12_23_1","doi-asserted-by":"publisher","DOI":"10.1002\/aet2.10329"},{"key":"e_1_2_12_24_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.chiabu.2020.104379"},{"key":"e_1_2_12_25_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.oooo.2023.04.019"},{"key":"e_1_2_12_26_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.annemergmed.2022.11.002"},{"key":"e_1_2_12_27_1","doi-asserted-by":"publisher","DOI":"10.1007\/s10459-018-9846-x"},{"key":"e_1_2_12_28_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpeds.2024.114183"},{"key":"e_1_2_12_29_1","first-page":"1231","article-title":"Learning Analytics to Enhance Dermatopathology Education Among Dermatology Residents","volume":"18","author":"Mu E. 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