手持式快速超声检查：一级城市创伤中心的手持式创伤超声检查经验
The hand-held FAST: experience with hand-held trauma sonography in a level-I urban trauma center.
作者信息
Kirkpatrick Andrew W, Simons Richard K, Brown Ross, Nicolaou Savvas, Dulchavsky Scott
机构信息
Department of Surgery, Vancouver Hospital and Health Sciences Center, Trauma Services, 3rd Floor, 855 West 10th Avenue, Vancouver, BC, Canada V5Z 1L7.
出版信息
Injury. 2002 May;33(4):303-8. doi: 10.1016/s0020-1383(02)00017-7.
AIMS
To describe the effectiveness of a portable hand-held ultrasound machine when used by clinicians in the early evaluation and resuscitation of trauma victims.
METHODS
The study was a prospective evaluation in a level-I urban trauma center. The focussed assessment with sonography for trauma is a specifically defined examination for free fluid known as the focused assessment with sonography for trauma (FAST) exam. Seventy-one patients had a hand-held FAST (HHFAST) examination performed with a Sonosite 180, 2.4 kg ultrasound machine. Sixty-seven examinations were immediately repeated with a Toshiba SSH 140A portable floor-based machine. This repeat scan (formal FAST or FFAST) was used as a comparison standard between the devices for study purposes. Four patients had a HHFAST only, all with positive result, two being taken for immediate laparotomy, and two having a follow-up computed tomographic (CT) scan. Patient follow-up from other imaging studies, operative intervention, and clinical outcomes were also compared to the performance of each device.
RESULTS
There were 58 victims of blunt, and 13 of penetrating abdominal trauma. One examination was indeterminate using both machines. The apparent HHFAST performance yielded; sensitivity, specificity, positive predictive value, negative predictable value, and accuracy (S, S, PPV, NPV, A) of 83, 100, 100, 98, 98%. Upon review, a CT scan finding and benign clinical course found the HHFAST diagnosis to be correct rather than the FFAST in one case. Considering the ultimate clinical course of the patients, yielded a (S, S, PPV, NPV, A) of 78, 100, 100, 97, and 97% for the HHFAST and 75, 98, 86, 97, and 96% for the FFAST. Statistically, there was no significant difference in the actual performance of the HHFAST compared to the FFAST in this clinical setting.
DISCUSSION
Hand-held portable sonography can simplify early and accurate performance of FAST exams in victims of abdominal trauma.
目的
描述临床医生使用便携式手持超声仪对创伤患者进行早期评估和复苏时的有效性。
方法
本研究是在一级城市创伤中心进行的前瞻性评估。创伤超声重点评估是一种专门针对游离液体的特定检查，称为创伤超声重点评估（FAST）检查。71例患者使用一台2.4千克的索诺声180型超声仪进行了手持FAST（HHFAST）检查。立即使用东芝SSH 140A便携式落地式超声仪对67例检查进行了重复检查。为了研究目的，将这次重复扫描（正式FAST或FFAST）用作两台设备之间的比较标准。4例患者仅进行了HHFAST检查，结果均为阳性，其中2例立即接受剖腹手术，2例进行了后续计算机断层扫描（CT）。还将其他影像学检查、手术干预和临床结果的患者随访情况与每种设备的性能进行了比较。
结果
有58例钝性伤患者和13例穿透性腹部创伤患者。两台机器的一次检查结果均不确定。HHFAST的表现为：敏感性、特异性、阳性预测值、阴性预测值和准确性（S、Sp、PPV、NPV、A）分别为83%、100%、100%、98%、98%。经复查，CT扫描结果和良性临床病程发现，在1例病例中HHFAST诊断正确而非FFAST。考虑到患者的最终临床病程，HHFAST的（S、Sp、PPV、NPV、A）分别为78%、100%、100%、97%和97%，FFAST的分别为75%、98%、86%、97%和96%。在统计学上，在这种临床环境中，HHFAST与FFAST的实际性能没有显著差异。
讨论
手持便携式超声检查可简化腹部创伤患者FAST检查的早期准确操作。
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