Kendall J L, Shimp R J
Department of Emergency Medicine, Denver Health Medical Center, 777 Bannock Street, Denver, CO 80204, USA.
J Emerg Med. 2001 Jul;21(1):7-13. doi: 10.1016/s0736-4679(01)00329-8.
The objectives of this study were to determine the accuracy of Emergency Physicians (EP) performing focused right upper quadrant (RUQ) ultrasound, to quantify how sonographic experience affects accuracy for gallbladder pathology, and to establish the time needed to complete a focused RUQ ultrasound. A convenience sample of patients with suspected gallbladder disease received a focused RUQ ultrasound by an EP. Sonographic findings, number of previous RUQ ultrasounds performed, and time for examination completion were recorded. Each patient then had a formal RUQ ultrasound by a sonographer blinded to the focused RUQ ultrasound results. Focused RUQ and formal ultrasound findings were compared, with the exception of the sonographic Murphy sign, which was compared to pathology reports. One hundred nine patients were enrolled. Fifty-one had gallstones. Forty-nine were detected by EPs, yielding a sensitivity of 96% [95% confidence interval (CI).87-.99]. Of the 58 patients without gallstones, 51 were correctly diagnosed by EPs (specificity = 88%, 95% CI.77-.95). The sonographic Murphy sign was present during 54 emergency examinations, but in only 24 formal studies. When compared to pathology reports, the emergency sonographic Murphy sign had a sensitivity of 75% compared to the formal ultrasound sensitivity of 45% for acute cholecystitis. EPs were less accurate for other sonographic findings, and level of experience had little effect on sensitivity or specificity for detecting gallstones. Eighty-three percent of emergency studies were completed in less than 10 min. Gallstones are accurately detected by EPs in a timely fashion. Additionally, compared to the radiologist's interpretation, the EP-detected sonographic Murphy sign was more sensitive for diagnosing acute cholecystitis.
本研究的目的是确定急诊医师（EP）进行右上腹（RUQ）重点超声检查的准确性，量化超声检查经验如何影响胆囊病变的诊断准确性，并确定完成一次右上腹重点超声检查所需的时间。选取了一组疑似胆囊疾病的患者作为便利样本，由急诊医师进行右上腹重点超声检查。记录超声检查结果、之前进行右上腹超声检查的次数以及检查完成时间。然后，由一名对右上腹重点超声检查结果不知情的超声检查人员为每位患者进行正式的右上腹超声检查。除了将超声墨菲氏征与病理报告进行比较外，将重点右上腹超声检查结果与正式超声检查结果进行比较。共纳入109例患者。51例有胆结石。急诊医师检测出49例，灵敏度为96%[95%置信区间（CI）.87-.99]。在58例无胆结石的患者中，急诊医师正确诊断出51例（特异度=88%，95%CI.77-.95）。54例急诊检查中出现超声墨菲氏征，但正式检查中仅24例出现。与病理报告相比，急诊超声墨菲氏征对急性胆囊炎的灵敏度为75%，而正式超声检查的灵敏度为45%。急诊医师对其他超声检查结果的准确性较低，经验水平对胆结石检测的灵敏度或特异度影响不大。83%的急诊检查在不到10分钟内完成。急诊医师能够及时准确地检测出胆结石。此外，与放射科医生的解读相比，急诊医师检测到的超声墨菲氏征对急性胆囊炎的诊断更敏感。
