Lanoix R, Leak L V, Gaeta T, Gernsheimer J R
Department of Emergency Medicine, Lincoln Medical and Mental Health Center, New York, NY, USA.
Am J Emerg Med. 2000 Jan;18(1):41-5. doi: 10.1016/s0735-6757(00)90046-9.
In this article we seek to evaluate the diagnostic accuracy of emergency physicians performing emergency ultrasonography in the setting of an emergency medicine training program. A prospective observational study was performed at an inner city Level I trauma center with an emergency medicine residency training program. From July 1994 to December 1996 a convenience sample of ultrasound exams was recorded. The diagnostic quality ("acceptable or technically limited") was determined by a board-certified cardiologist or radiologist with fellowship training in ultrasonography. The emergency department interpretations were then compared to those of the blinded cardiologist or radiologist. Four hundred and fifty-six ultrasound examinations were videotaped and entered into the study; 408 (89%) of the studies performed were determined to be "acceptable." The diagnostic accuracy (sensitivity, specificity, positive and negative predictive values) of these studies were as follows: cardiac, to rule out effusion (n = 67; 0.83, 0.98, 0.88, 0.98); transabdominal, to rule out abdominal aortic aneurysms (AAA), cholelithiasis, or free peritoneal fluid (n = 263; 0.91, 0.89, 0.88, 0.92); renal, to rule out hydronephrosis (n = 45; 0.94, 0.96, 0.94, 0.96); pelvic, to rule in intrauterine pregnancy (n = 33; 1.0, 0.90, 0.96, 1.0). The 48 "technically limited studies" included: 39 transabdominal (33 gallbladder, 1 abdominal aortic aneurysm, 5 free peritoneal fluid), 6 cardiac, 2 renal, and 1 pelvic ultrasound. This study suggests that emergency physicians with a minimal amount of training display acceptable technical skill and interpretive acumen in their approach to emergency ultrasonography.
在本文中，我们旨在评估在急诊医学培训项目背景下，急诊医生进行急诊超声检查的诊断准确性。在一家设有急诊医学住院医师培训项目的市中心一级创伤中心进行了一项前瞻性观察研究。从1994年7月至1996年12月，记录了方便抽样的超声检查。诊断质量（“可接受或技术受限”）由一名经过超声检查专项培训的委员会认证心脏病专家或放射科医生确定。然后将急诊科的解读结果与不知情的心脏病专家或放射科医生的解读结果进行比较。456次超声检查被录像并纳入研究；其中408次（89%）检查被判定为“可接受”。这些检查的诊断准确性（敏感性、特异性、阳性和阴性预测值）如下：心脏检查，用于排除心包积液（n = 67；0.83、0.98、0.88、0.98）；经腹检查，用于排除腹主动脉瘤（AAA）、胆结石或游离腹腔积液（n = 263；0.91、0.89、0.88、0.92）；肾脏检查，用于排除肾积水（n = 45；0.94、0.96、0.94、0.96）；盆腔检查，用于确定宫内妊娠（n = 33；1.0、0.90、0.96、1.0）。48项“技术受限检查”包括：39项经腹检查（33项胆囊检查、1项腹主动脉瘤检查、5项游离腹腔积液检查）、6项心脏检查、2项肾脏检查和1项盆腔超声检查。这项研究表明，接受过最少培训的急诊医生在进行急诊超声检查时，展现出了可接受的技术水平和解读能力。
