Ghane Mohammad Reza, Gharib Mohammad Hadi, Ebrahimi Ali, Samimi Kaveh, Rezaee Maryam, Rasouli Hamid Reza, Kazemi Hossein Mohammad
Trauma Research Center, Baqiyatallah University of Medical Science, Tehran, IR Iran.
Radiology Department, Iran University of Medical Science, IR Iran.
Trauma Mon. 2015 Feb;20(1):e20095. doi: 10.5812/traumamon.20095. Epub 2015 Feb 20.
Rapid ultrasound in shock (RUSH) is the most recent emergency ultrasound protocol, designed to help clinicians better recognize distinctive shock etiologies in a shorter time frame.
In this study, we evaluated the accuracy of the RUSH protocol, performed by an emergency physician or radiologist, in predicting the type of shock in critical patients.
An emergency physician or radiologist performed the RUSH protocol for all patients with shock status at the emergency department. All patients were closely followed to determine their final clinical diagnosis. The agreement between the initial impression provided by RUSH and the final diagnosis was investigated by calculating the Kappa index. Sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of RUSH for diagnosis of each case.
We performed RUSH on 77 patients. Kappa index was 0.71 (P Value = 0.000), reflecting acceptable general agreement between initial impression and final diagnosis. For hypovolemic, cardiogenic and obstructive shock, the protocol had an NPV above 97% yet it had a lower PPV. For shock with distributive or mixed etiology, RUSH showed a PPV of 100% but it had low sensitivity. Subgroup analysis showed a similar Kappa index for the emergency physician and radiologist (0.70 and 0.73, respectively) in performing rush.
This study highlights the role of the RUSH exam performed by an emergency physician, to make a rapid and reliable diagnosis of shock etiology, especially in order to rule out obstructive, cardiogenic and hypovolemic shock types in initial exam of shock patients.
休克快速超声检查（RUSH）是最新的急诊超声检查方案，旨在帮助临床医生在更短时间内更好地识别不同的休克病因。
在本研究中，我们评估了由急诊医生或放射科医生执行的RUSH方案在预测重症患者休克类型方面的准确性。
急诊医生或放射科医生对急诊科所有休克患者执行RUSH方案。对所有患者进行密切随访以确定其最终临床诊断。通过计算Kappa指数来研究RUSH提供的初始印象与最终诊断之间的一致性。计算RUSH对各病例诊断的敏感性、特异性、阳性预测值（PPV）和阴性预测值（NPV）。
我们对77例患者进行了RUSH检查。Kappa指数为0.71（P值 = 0.000），表明初始印象与最终诊断之间总体一致性可接受。对于低血容量性、心源性和梗阻性休克，该方案的NPV高于97%，但PPV较低。对于分布性或混合性病因的休克，RUSH的PPV为100%，但敏感性较低。亚组分析显示急诊医生和放射科医生在执行RUSH时的Kappa指数相似（分别为0.70和0.73）。
本研究强调了急诊医生执行RUSH检查在快速、可靠地诊断休克病因方面的作用，特别是在休克患者的初始检查中排除梗阻性、心源性和低血容量性休克类型。
