Department of Emergency Medicine, University of Virginia, Charlottesville, VA 22908, USA.
Am J Emerg Med. 2012 Jan;30(1):218-21. doi: 10.1016/j.ajem.2010.11.024. Epub 2010 Dec 24.
To determine whether ultrasound changes emergency physicians' estimated likelihood of acute ureterolithiasis in patients with flank pain.
This prospective, observational study enrolled patients awaiting computed tomographic (CT) scan for presumed renal colic. Using a visual analogue scale, treating physicians estimated the likelihood of acute ureterolithiasis based first on clinical findings and urinalysis, then after ultrasound, and finally after CT. A 20% change in estimated likelihood was considered clinically significant. Test characteristics of ultrasound for any ureteral stone and for those greater than or equal to 5 mm in size were determined.
One hundred seven patients were enrolled. Sensitivity, specificity, and negative predictive value of ultrasound for stones observed on CT were 76.3% (95% confidence interval [CI], 59.4%-88.0%), 78.3% (95% CI, 66.4%-86.9%), and 85.7% (95% CI, 74.1%-92.9%) respectively, and for stones >5 mm 90.0% (95% CI, 54.1%-99.5%), 63.9% (95% CI, 53.4%-73.2%), and 98.4% (95% CI, 90.3%-99.9%), respectively. Ultrasound significantly impacted the estimated likelihood of disease in 33 of 107 cases (30.8%, 95% CI, 22.5%-40.6%). Computed tomography further significantly changed physicians' impression of disease in 55 of 107 cases (51.4%, 95% CI, 41.6%-61.1%).
Bedside renal ultrasound had only a limited impact on the physicians' clinical impression of patients with possible ureterolithiasis. The sensitivity of sonographic hydronephrosis was modest for detecting any ureteral stone, but much better for detecting a large stone. Further study is needed to define the precise role ultrasound should play in evaluating patients with suspected ureterolithiasis.
确定在出现腰痛的患者中，超声检查是否会改变急诊医师对急性输尿管结石的预估可能性。
这项前瞻性观察性研究纳入了等待计算机断层扫描（CT）检查以明确是否存在肾绞痛的患者。治疗医师使用视觉模拟评分法（VAS），首先根据临床发现和尿液分析对急性输尿管结石的可能性进行评估，然后进行超声检查，最后进行 CT 检查。将预估可能性的 20%变化视为具有临床意义。确定了超声对任何输尿管结石以及对大于或等于 5mm 大小的结石的检测特征。
共纳入 107 例患者。超声对 CT 所见结石的敏感度、特异度和阴性预测值分别为 76.3%（95%置信区间[CI]，59.4%-88.0%）、78.3%（95% CI，66.4%-86.9%）和 85.7%（95% CI，74.1%-92.9%），对大于 5mm 的结石的敏感度、特异度和阴性预测值分别为 90.0%（95% CI，54.1%-99.5%）、63.9%（95% CI，53.4%-73.2%）和 98.4%（95% CI，90.3%-99.9%）。在 107 例患者中，超声检查显著影响了 33 例（30.8%，95% CI，22.5%-40.6%）患者疾病的预估可能性。CT 进一步显著改变了 107 例患者中 55 例（51.4%，95% CI，41.6%-61.1%）患者的疾病印象。
床边肾脏超声检查仅对可能患有输尿管结石的患者的临床印象产生有限影响。超声检查肾积水对检测任何输尿管结石的敏感性适中，但对检测大结石的敏感性更好。需要进一步研究来确定超声在评估疑似输尿管结石患者中的确切作用。
