Gustafsson Camilla, McNicholas Andrea, Sondén Anders, Törngren Staffan, Järnbert-Pettersson Hans, Lindelius Anna
Department of Clinical Science and Education, Department of Surgery, Karolinska Institutet, Södersjukhuset (Stockholm South General Hospital), Sjukhusbacken 10, 118 83, Stockholm, Sweden.
Department of Clinical Science and Education, Karolinska Institutet, Södersjukhuset (Stockholm South General Hospital), Sjukhusbacken 10, 118 83, Stockholm, Sweden.
World J Surg. 2016 Jul;40(7):1688-94. doi: 10.1007/s00268-016-3468-3.
Symptomatic gallstone disease is a common diagnosis in patients with abdominal pain. Ultrasound is considered the gold standard method to identify gallstones. Today the examination may be performed bedside by the treating clinician. Bedside ultrasound could provide a safe and time-saving diagnostic resource for surgeons evaluating patients with suspected symptomatic gallstones; however, large validation studies of the accuracy and reliability are lacking. The aim of this study was to prospectively investigate the accuracy of surgeon-performed ultrasound for the detection of gallstones.
Between October 2011 and November 2012, 179 adult patients, with an acute or elective referral for an abdominal ultrasound examination, were examined with a right upper quadrant ultrasound scan by a radiologist as well as a surgeon. The surgeons had undergone a four-week-long ultrasound education before participating in the study. Ultrasound findings of the surgeon were compared to those of the radiologist, using radiologist-performed ultrasound as reference standard.
Surgeon-performed ultrasound agreed with radiologist findings in 169 of 179 patients regarding the detection of gallstones, providing an accuracy of 94 %. The sensitivity was 88 % (67/76), specificity 99 % (102/103), positive predictive value 99 % (67/68), and negative predictive value 92 % (102/111). Agreement between the diagnosis set by the radiologists and the surgeons was high: Cohen's Kappa coefficient = 0.88.
Ultrasound-trained surgeons may accurately diagnose gallstones using ultrasound and reach a high level of agreement with radiologists.
有症状的胆结石疾病是腹痛患者的常见诊断。超声被认为是识别胆结石的金标准方法。如今，该检查可由主治医生在床边进行。床边超声可为评估疑似有症状胆结石患者的外科医生提供一种安全且节省时间的诊断资源；然而，缺乏关于其准确性和可靠性的大型验证研究。本研究的目的是前瞻性地调查外科医生进行超声检查检测胆结石的准确性。
在2011年10月至2012年11月期间，179名因急性或择期接受腹部超声检查转诊的成年患者接受了放射科医生以及外科医生的右上腹超声扫描检查。外科医生在参与研究前接受了为期四周的超声培训。以外科医生进行的超声检查结果与放射科医生的结果进行比较，将放射科医生进行的超声检查作为参考标准。
在179名患者中，外科医生进行的超声检查在胆结石检测方面与放射科医生的结果一致的有169例，准确率为94%。敏感性为88%（67/76），特异性为99%（102/103），阳性预测值为99%（67/68），阴性预测值为92%（102/111）。放射科医生和外科医生设定的诊断之间的一致性很高：科恩kappa系数=0.88。
经过超声培训的外科医生使用超声可准确诊断胆结石，并与放射科医生达成高度一致。
