Department of Emergency Medicine, SUNY Downstate Medical Center, Brooklyn, NY, USA.
Acad Emerg Med. 2013 Feb;20(2):128-38. doi: 10.1111/acem.12080.
The use of ultrasound (US) to diagnose an abdominal aortic aneurysm (AAA) has been well studied in the radiology literature, but has yet to be rigorously reviewed in the emergency medicine arena.
This was a systematic review of the literature for the operating characteristics of emergency department (ED) ultrasonography for AAA.
The authors searched PubMed and EMBASE databases for trials from 1965 through November 2011 using a search strategy derived from the following PICO formulation: Patients-patients (18+ years) suspected of AAA. Intervention-bedside ED US to detect AAA. Comparator-reference standard for diagnosing an AAA was a computed tomography (CT), magnetic resonance imaging (MRI), aortography, official US performed by radiology, ED US reviewed by radiology, exploratory laparotomy, or autopsy results. AAA was defined as ≥ 3 cm dilation of the aorta. Outcome-operating characteristics (sensitivity, specificity, and likelihood ratios [LR]) of ED abdominal US. The papers were analyzed using Quality Assessment of Diagnostic Accuracy Studies (QUADAS) guidelines.
The initial search strategy identified 1,238 articles; application of inclusion/exclusion criteria resulted in seven studies with 655 patients. The weighted average prevalence of AAA in symptomatic patients over the age of 50 years is 23%. On history, 50% of AAA patients will lack the classic triad of hypotension, back pain, and pulsatile abdominal mass. The sensitivity of abdominal palpation for AAA increases as the diameter of the AAA increases. The pooled operating characteristics of ED US for the detection of AAA were sensitivity 99% (95% confidence interval [CI] = 96% to 100%) and specificity 98% (95% CI = 97% to 99%).
Seven high-quality studies of the operating characteristics of ED bedside US in diagnosing AAA were identified. All showed excellent diagnostic performance for emergency bedside US to detect the presence of AAA in symptomatic patients.
超声（US）在放射学文献中已被广泛研究用于诊断腹主动脉瘤（AAA），但在急诊医学领域尚未得到严格审查。
这是对急诊超声（EDUS）诊断 AAA 的操作特性进行的系统综述。
作者使用从以下 PICO 公式推导的搜索策略，在 1965 年至 2011 年 11 月期间在 PubMed 和 EMBASE 数据库中搜索试验：患者-疑似 AAA 的患者（18 岁以上）。干预-床边 EDUS 用于检测 AAA。将 AAA 的诊断参考标准定义为计算机断层扫描（CT）、磁共振成像（MRI）、血管造影、放射科进行的正式 US、放射科审查的 EDUS、剖腹探查术或尸检结果。AAA 定义为主动脉扩张≥3cm。结局-ED 腹部 US 的操作特性（敏感性、特异性和似然比[LR]）。使用诊断准确性研究质量评估（QUADAS）指南分析论文。
初始搜索策略确定了 1238 篇文章；应用纳入/排除标准后，有 7 项研究纳入了 655 名患者。50 岁以上有症状患者 AAA 的加权平均患病率为 23%。在病史方面，50%的 AAA 患者将缺乏低血压、背痛和搏动性腹部肿块的经典三联征。随着 AAA 直径的增加，腹部触诊对 AAA 的敏感性增加。EDUS 检测 AAA 的汇总操作特性为敏感性 99%（95%置信区间[CI] = 96%至 100%）和特异性 98%（95%CI = 97%至 99%）。
确定了 7 项高质量的 ED 床边 US 诊断 AAA 的操作特性研究。所有研究均表明，急诊床边 US 对诊断有症状患者 AAA 的存在具有出色的诊断性能。
Zotero 插件