Davis Daniel P, Campbell Colleen J, Poste Jennifer C, Ma Gene
Department of Emergency Medicine, University of California, San Diego, San Diego, California 92103-8676, USA.
J Emerg Med. 2005 Oct;29(3):259-64. doi: 10.1016/j.jemermed.2005.02.008.
The variable accuracy of emergency department (ED) ultrasound described in the literature has limited its utility as the sole imaging modality in critical decision making. Although ultrasound accuracy is highly dependent upon the technical abilities of the operator and conditions unique to each patient, no previous study of ED ultrasound has included estimates of operator confidence. This prospective observational study explores the association between operator confidence and the accuracy of ED ultrasound. Ultrasound was not performed in our ED until a formal training module was instituted. Patients were enrolled prospectively for the first year following the training module if they underwent one of the following ultrasound studies: abdominal examination for intraperitoneal fluid, right upper quadrant examination for gallstones, renal examination for hydronephrosis, pelvic examination for intrauterine pregnancy, abdominal examination for aorta diameter > 3 cm, or cardiac examination for pericardial fluid. In addition, formal ultrasound, computed tomography, magnetic resonance imaging, or an invasive procedure was required as a "gold standard" for each patient. Operators recorded their interpretation of the ED ultrasound and rated their confidence with the analysis before the formal imaging study or procedure. Test performance characteristics for each examination type and for all studies together were determined. The association between operator confidence and accuracy was explored using logistic regression and by determining test performance characteristics with patients stratified by confidence value. A total of 276 ED ultrasound studies were included. There were no significant differences in accuracy between ED attendings and residents. Overall accuracy, sensitivity, specificity, LR+, and LR- were 90%, 92%, 86%, 6.8, and 0.09, respectively. With confidence scores of 9 or 10 (n = 113), these values improved to 96%, 99%, 90%, 9.6, and 0.01, respectively. Logistic regression revealed an association between confidence and ED ultrasound accuracy (p < 0.001). It is concluded that a significant association exists between operator confidence and the accuracy of ED ultrasound. High confidence values are associated with clinically useful test performance characteristics.
文献中所描述的急诊科超声检查的可变准确性，限制了其作为关键决策中唯一成像方式的效用。尽管超声检查的准确性高度依赖于操作者的技术能力以及每个患者的独特情况，但此前尚无关于急诊科超声检查的研究纳入对操作者信心的评估。这项前瞻性观察性研究探讨了操作者信心与急诊科超声检查准确性之间的关联。在设立正式培训模块之前，我们急诊科未开展超声检查。在培训模块实施后的第一年，前瞻性纳入患者，若他们接受了以下超声检查之一：用于检查腹腔内液体的腹部检查、用于检查胆结石的右上腹检查、用于检查肾积水的肾脏检查、用于检查宫内妊娠的盆腔检查、用于检查腹主动脉直径>3 cm的腹部检查，或用于检查心包积液的心脏检查。此外，每位患者均需进行正式超声检查、计算机断层扫描、磁共振成像或侵入性操作作为“金标准”。操作者在正式成像检查或操作之前记录他们对急诊科超声检查的解读，并对分析的信心进行评分。确定了每种检查类型以及所有研究的总体测试性能特征。使用逻辑回归并通过对按信心值分层的患者确定测试性能特征，探讨了操作者信心与准确性之间的关联。总共纳入了276项急诊科超声检查。急诊科主治医师和住院医师之间的准确性无显著差异。总体准确性、敏感性、特异性、阳性似然比和阴性似然比分别为90%、92%、86%、6.8和0.09。信心评分为9或10（n = 113）时，这些值分别提高到96%、99%、90%、9.6和0.01。逻辑回归显示信心与急诊科超声检查准确性之间存在关联（p < 0.001）。得出的结论是，操作者信心与急诊科超声检查准确性之间存在显著关联。高信心值与具有临床实用价值的测试性能特征相关。
