Lapostolle Frédéric, Petrovic Tomislav, Lenoir Gilles, Catineau Jean, Galinski Michel, Metzger Jacques, Chanzy Erick, Adnet Frédérick
SAMU 93, UPRES 3409, Université Paris XIII, Hôpital Avicenne, Bobigny, France.
Am J Emerg Med. 2006 Mar;24(2):237-42. doi: 10.1016/j.ajem.2005.07.010.
To evaluate the usefulness of ultrasonographic examinations as a diagnostic tool for emergency physicians in out-of-hospital settings.
Prospective study performed in a French teaching hospital. Eight emergency physicians given ultrasound training for out-of-hospital diagnosis of pleural, peritoneal, or pericardial effusion; deep venous thrombosis; and arterial flow interruption. After clinical examination, a probability of diagnosis ("clinical score") was assigned on visual analog scale from 0 (absent lesion) to 10 (present lesion). Clinical score between 3 and 7 was considered as clinically doubtful. After ultrasound examination, a second probability ("ultrasound score") was similarly determined. Potential usefulness of ultrasound examination was evaluated by calculating the absolute difference between clinical and ultrasound scores. Patients were followed up to determine final diagnosis: present or absent lesion. "Ultrasound usefulness score" (USS) was determined attributing a positive (when ultrasonography increased diagnostic accuracy) or a negative (when ultrasonography decreased diagnostic accuracy) value to the absolute difference between clinical and ultrasound scores.
One hundred sixty-nine patients were included and 302 ultrasound examinations performed. Median duration of examination was 6 minutes (5-10 minutes). The suspected lesion was found in 45 cases (17%). Mean USS was +2 (0-4). Ultrasonographic examination improved diagnostic accuracy (ie, positive USS) in 181 (67%) cases, decreased it (ie, negative USS) in 22 (8%) cases, and was not contributive (ie, USS was 0) in 67 (25%) cases. When initial diagnosis was uncertain (n = 115), diagnostic performance reached +4 (3-5) and ultrasonographic examination improved diagnostic accuracy in 103 (90%) cases.
Out-of-hospital ultrasonography increased diagnostic accuracy in out-of-hospital settings.
评估超声检查作为一种诊断工具对院外环境中急诊医生的有用性。
在一家法国教学医院进行的前瞻性研究。八位接受过超声培训的急诊医生用于院外诊断胸腔、腹腔或心包积液；深静脉血栓形成；以及动脉血流中断。临床检查后，根据视觉模拟量表从0（无病变）到10（有病变）给出诊断概率（“临床评分”）。临床评分在3至7之间被认为临床诊断存疑。超声检查后，同样确定第二个概率（“超声评分”）。通过计算临床评分与超声评分之间的绝对差值来评估超声检查的潜在有用性。对患者进行随访以确定最终诊断：有或无病变。根据临床评分与超声评分之间绝对差值的正负情况来确定“超声有用性评分”（USS），正值表示超声检查提高了诊断准确性，负值表示超声检查降低了诊断准确性。
纳入169例患者，进行了302次超声检查。检查的中位持续时间为6分钟（5 - 10分钟）。在45例（17%）患者中发现了疑似病变。USS的平均值为 +2（0 - 4）。超声检查在181例（67%）病例中提高了诊断准确性（即USS为正值），在22例（8%）病例中降低了诊断准确性（即USS为负值），在67例（25%）病例中没有作用（即USS为0）。当初始诊断不确定时（n = 115），诊断效能达到 +4（3 - 5），超声检查在103例（90%）病例中提高了诊断准确性。
院外超声检查提高了院外环境中的诊断准确性。
