Bagheri-Hariri Shahram, Yekesadat Meysam, Farahmand Shervin, Arbab Mona, Sedaghat Mojtaba, Shahlafar Neda, Takzare Alireza, Seyedhossieni-Davarani Seyedhossein, Nejati Amir
Emergency Medicine Department, Tehran University of Medical Sciences, Tehran, Iran.
Emergency Department, Imam Khomeini Complex Hospital, Bagherkhan Ave, Tehran, 1419733141, Iran.
Emerg Radiol. 2015 Oct;22(5):517-20. doi: 10.1007/s10140-015-1311-z. Epub 2015 Mar 21.
Clinical assessment and classification of shock is extremely difficult to conduct on critically ill patients especially upon arrival at the emergency department. Resuscitative point-of-care ultrasound could be used for rapid initial diagnosis and better management. In this study, the results of using the RUSH (Rapid Ultrasound in Shock) exam to determine the type of shock in the emergency department are compared to the final diagnosis of patients. This was a single-center prospective study in which all patients with an unknown type of shock and no prior treatment were included. Parallel to the standard resuscitative management and diagnosis of the emergency team, the RUSH exam was performed blindly on the patient by an emergency medicine staff who was not part of the patient's caregiving team. The results of the RUSH exam were then compared to the final diagnosis of the patients and the 48-h outcome. Twenty-five patients were enrolled in this study. The overall kappa correlation of the RUSH exam compared with the final diagnosis was 0.84 which is an almost perfect agreement. The overall sensitivity of the RUSH exam was 88 % and the specificity was 96 %. Although the mortality rate was 64 %, there was not a significant relationship between mortality and the protocol used for diagnosis. The RUSH exam could be used in emergency wards to detect types of shock.
对危重症患者进行休克的临床评估和分类极为困难，尤其是在刚送至急诊科时。床旁复苏超声检查可用于快速初步诊断和更好地管理。在本研究中，将在急诊科使用RUSH（休克快速超声）检查来确定休克类型的结果与患者的最终诊断进行比较。这是一项单中心前瞻性研究，纳入了所有休克类型不明且未接受过先前治疗的患者。在急诊团队进行标准复苏管理和诊断的同时，由不属于患者护理团队的一名急诊医学人员对患者进行盲法RUSH检查。然后将RUSH检查的结果与患者的最终诊断及48小时预后进行比较。本研究共纳入了25例患者。RUSH检查与最终诊断相比的总体kappa相关性为0.84，几乎完全一致。RUSH检查的总体敏感性为88%，特异性为96%。尽管死亡率为64%，但死亡率与诊断所用方案之间无显著关系。RUSH检查可用于急诊病房以检测休克类型。
