Ziesmann Markus Tyler, Park Jason, Unger Bertram J, Kirkpatrick Andrew W, Vergis Ashley, Logsetty Sarvesh, Pham Chau, Kirschner David, Gillman Lawrence M
From the University of Manitoba, Winnipeg, Manitoba, Canada.
J Trauma Acute Care Surg. 2015 May;78(5):1008-13. doi: 10.1097/TA.0000000000000639.
The Focused Assessment with Sonography for Trauma (FAST) examination has become a valuable tool in trauma resuscitation. Despite the widespread use of FAST training among traumatologists, no evidence-based guidelines exist to support optimal training requirements or to provide quantitative objective assessments of imaging capabilities. Both Task-Specific Checklist (TSC) and Global Rating Scale (GRS) have been validated as objective skill assessment tools; we developed both types of scoring checklist and assessed them for construct validity with the FAST examination.
Two scoring checklists, collectively termed the Quality of Ultrasound Imaging and Competence (QUICk) Score, were developed and subjected to a modified Delphi consensus process. Two cohorts of 12 novice and 12 expert sonographers performed the FAST examination and were evaluated by two experts according to the QUICk model. Total scores as well as anatomic subsets were compared via comparison of means, and logistic regression modeling was used to determine sensitivity and specificity.
Experts achieved significantly higher total scores than novices on both scoring systems (17.2 vs. 11.1 of 24, p < 0.01 TSC, 29.8 vs. 18.4 of 40, p < 0.01 GRS). Sensitivity (85.7% TSC, 92.9% GRS) and specificity (75.0% TSC, 91.7% GRS) as well as area under the receiver operating characteristic curve (89.9% TSC, 97.6% GRS) were consistent with a highly discriminant tool.
The QUICk Score is the first validated objective tool for assessment of the quality of FAST examination imaging. Use of this tool may be instrumental in developing an evidence-based minimum-performance standard and for assessing quality-improvement modifications in FAST examination training.
创伤超声重点评估（FAST）检查已成为创伤复苏中的一项重要工具。尽管创伤科医生广泛开展了FAST培训，但尚无基于证据的指南来支持最佳培训要求或提供成像能力的定量客观评估。特定任务检查表（TSC）和整体评分量表（GRS）均已被验证为客观技能评估工具；我们开发了这两种评分检查表，并通过FAST检查评估它们的结构效度。
开发了两种评分检查表，统称为超声成像质量与能力（QUICk）评分，并进行了改良的德尔菲共识流程。两组各12名新手和12名专家级超声检查人员进行FAST检查，并由两名专家根据QUICk模型进行评估。通过均值比较来比较总分以及解剖部位子集，并使用逻辑回归模型来确定敏感性和特异性。
在两种评分系统中，专家的总分均显著高于新手（TSC：24分中专家为17.2分，新手为11.1分，p<0.01；GRS：40分中专家为29.8分，新手为18.4分，p<0.01）。敏感性（TSC为85.7%，GRS为92.9%）、特异性（TSC为75.0%，GRS为91.7%）以及受试者操作特征曲线下面积（TSC为89.9%，GRS为97.6%）均表明该工具具有高度鉴别力。
QUICk评分是首个经过验证的用于评估FAST检查成像质量的客观工具。使用该工具可能有助于制定基于证据的最低性能标准，并评估FAST检查培训中的质量改进措施。
