Henwood Patricia C, Mackenzie David C, Liteplo Andrew S, Rempell Joshua S, Murray Alice F, Leo Megan M, Dukundane Damas, Dean Anthony J, Rulisa Stephen, Noble Vicki E
Department of Emergency Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Department of Emergency Medicine, Maine Medical Center, Portland, Maine, USA.
J Ultrasound Med. 2017 Jun;36(6):1189-1194. doi: 10.7863/ultra.16.05073. Epub 2017 Mar 4.
Few studies of point-of-care ultrasound training and use in low resource settings have reported the impact of examinations on clinical management or the longer-term quality of trainee-performed studies. We characterized the long-term effect of a point-of-care ultrasound program on clinical decision making, and evaluated the quality of clinician-performed ultrasound studies.
We conducted point-of-care ultrasound training for physicians from Rwandan hospitals. Physicians then used point-of-care ultrasound and recorded their findings, interpretation, and effects on patient management. Data were collected for 6 months. Trainee studies were reviewed for image quality and accuracy.
Fifteen participants documented 1158 ultrasounds; 590 studies (50.9%) had matched images and interpretations for review. Abdominal ultrasound for free fluid was the most frequently performed application. The mean image quality score was 2.36 (95% confidence interval, 2.28-2.44). Overall sensitivity and specificity for trainee-performed examinations was 94 and 98%. Point-of-care ultrasound use most commonly changed medications administered (42.4%) and disposition (30%).
A point-of-care ultrasound training intervention in a low-resource setting resulted in high numbers of diagnostic-quality studies over long-term follow-up. Ultrasound use routinely changed clinical decision making.
在资源匮乏地区，很少有关于床旁超声培训及使用的研究报告检查对临床管理的影响或学员所做研究的长期质量。我们描述了一项床旁超声项目对临床决策的长期影响，并评估了临床医生所做超声研究的质量。
我们为卢旺达医院的医生开展了床旁超声培训。医生们随后使用床旁超声，并记录他们的检查结果、解读以及对患者管理的影响。数据收集了6个月。对学员的研究进行图像质量和准确性评估。
15名参与者记录了1158次超声检查；590项研究（50.9%）有匹配的图像和解读可供审查。用于检测游离液体的腹部超声是最常进行的应用。平均图像质量评分为2.36（95%置信区间，2.28 - 2.44）。学员所做检查的总体敏感性和特异性分别为94%和98%。床旁超声的使用最常改变给药方式（42.4%）和处置方式（30%）。
在资源匮乏地区进行的一项床旁超声培训干预在长期随访中产生了大量诊断质量的研究。超声的使用常规性地改变了临床决策。
