Levine Matthew R, Gorman Stephen M, Yarnold Paul R
Department of Emergency Medicine, Northwestern University, Feinberg School of Medicine, 259 East Erie Street, Suite 100, Chicago, IL 60611, USA.
Emerg Med J. 2007 Jun;24(6):413-6. doi: 10.1136/emj.2007.047340.
Emergency physicians often manage wounds contaminated with glass. Even when glass is visible on x rays, removal may require real-time bedside imaging.
To assess whether novices can be easily trained to accurately detect tiny glass foreign bodies (GFBs) using low-power portable fluoroscopy.
21 medical students with no prior experience using fluoroscopy were taught to detect 1 mm GFBs in chicken legs either by training over three separate days or by training on 1 day. Skills were reassessed at 3 months. The number of mean correct responses was compared between groups using analysis of variance (ANOVA) and by examination of 95% CIs.
Examination of CI overlap and ANOVA suggested that asymptotic accuracy was achieved after 15-30 training specimens. The final accuracy was similar between protocols, was comparable to prior accuracy reports of plain film radiography and was maintained in both protocols at the 3 month follow-up: 10.9 (0.3) and 12.0 (0.8; out of 15).
Novices can easily be taught to detect GFBs using fluoroscopy, with accuracy comparable to that achieved by radiologists using plain films. Further studies are needed to assess doctors' use of the technique in real patients.
急诊医生经常处理被玻璃污染的伤口。即使在X射线下能看到玻璃，取出玻璃可能仍需要床边实时成像。
评估新手是否能通过低功率便携式荧光透视法轻松学会准确检测微小玻璃异物（GFB）。
对21名此前无荧光透视使用经验的医学生进行培训，让他们检测鸡腿中的1毫米GFB，培训方式为分三天进行或集中在一天进行。三个月后重新评估技能。使用方差分析（ANOVA）并通过检查95%置信区间比较两组之间的平均正确反应数量。
对置信区间重叠情况的检查和方差分析表明，经过15 - 30个训练样本后可达到渐近准确性。两种方案最终的准确性相似，与之前普通X线摄影的准确性报告相当，且在三个月随访时两种方案的准确性均得以保持：分别为10.9（0.3）和12.0（0.8；满分15分）。
新手能够轻松学会使用荧光透视法检测GFB，其准确性与放射科医生使用普通X线片时相当。需要进一步研究评估医生在实际患者中对该技术的应用情况。
