重新评估用于定位肝缘的划痕试验。

A re-evaluation of the scratch test for locating the liver edge.

机构信息

John Hunter Hospital, Division of Medicine, Lookout Rd, 2305, New Lambton Heights, NSW, Australia.

出版信息

BMC Gastroenterol. 2013 Feb 25;13:35. doi: 10.1186/1471-230X-13-35.

DOI:10.1186/1471-230X-13-35

PMID:23442829

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC3598244/

Abstract

BACKGROUND

A reliable and accurate estimation of liver size by physical examination is an important aspect of the clinical assessment of a patient. The scratch test uses auscultation to detect the lower liver edge by using the difference in sound transmission through the abdominal cavity over solid and hollow organs. The test is thought to be particularly useful if the abdomen is tense, distended, obese, or very tender. Although the sign is often taught to medical students and residents, the value of the technique for detecting the liver edge has become controversial.

METHODS

The study was performed in two parts. In the first part, 18 patients undergoing upper abdominal ultrasound as outpatients were randomly selected and the scratch test was performed by two raters independently, followed by ultrasound (USG) as the reference standard. In the second part of the study, the two raters independently performed the scratch test on separate randomly selected patients (15 patients by rater 1, and 16 patients by rater 2), followed by USG.

RESULTS

Agreement between raters on the scratch test was very high, with an intra-class correlation coefficient of 0.97. The agreement between the raters and the USG was 0.37 using Spearman's rho. A Bland -Altman plot indicated that, on average, raters underestimated the distance from the right costal margin to the liver edge by only about 2.4 centimeters compared to USG. This translates into 37% and 54% of raters' estimates falling within 2 and 3 cm of USG estimates. Each unit increase in BMI increased the discrepancy between raters and USG by 0.26 cm (p = 0.012).

CONCLUSION

The scratch test has very high reproducibility and overall agreement between the scratch test and USG was moderate, with a spearman's rho of 0.37. The accuracy may potentially be improved by using the point of initial sound transmission rather than the point of maximal transmission. We conclude that the scratch test deserves further investigation.

摘要

背景

通过体格检查可靠且准确地评估肝脏大小是对患者进行临床评估的重要方面。划痕试验通过听诊利用腹腔对实体和中空器官的不同声传输来检测肝下界。如果腹部紧张、膨胀、肥胖或非常敏感，该试验被认为特别有用。尽管该体征通常教授给医学生和住院医师，但该技术检测肝缘的价值已引起争议。

方法

该研究分两部分进行。在第一部分中，随机选择了 18 名接受上腹部超声检查的门诊患者，由两名评分者独立进行划痕试验，然后以超声检查（USG）为参考标准。在研究的第二部分中，两名评分者分别对单独随机选择的患者（评分者 1 进行 15 例，评分者 2 进行 16 例）进行划痕试验，然后进行 USG。

结果

评分者之间对划痕试验的一致性非常高，组内相关系数为 0.97。评分者与 USG 的一致性用 Spearman's rho 表示为 0.37。Bland -Altman 图表明，平均而言，与 USG 相比，评分者仅低估了从右肋缘到肝缘的距离约 2.4 厘米。这相当于 37%和 54%的评分者估计值落在 USG 估计值的 2 和 3 厘米内。BMI 每增加一个单位，评分者与 USG 之间的差异增加 0.26 厘米（p = 0.012）。