Haider Steffen J A, diFlorio-Alexander Roberta, Lam David H, Cho Joo Y, Sohn Jae Ho, Harris Robert
Department of Radiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.
Department of Medicine, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA.
J Ultrasound Med. 2017 Jul;36(7):1453-1460. doi: 10.7863/ultra.16.06084. Epub 2017 Mar 24.
To compare the diagnostic accuracy of hand-held point-of-care (POC) versus conventional sonography in a general diagnostic setting with the intention to inform medical providers or clinicians on the rational use of POC ultrasound in resource limited settings.
Over 3 months in 2010, 47 patients were prospectively enrolled at a single academic center to obtain 54 clinical conventional ultrasound examinations and 54 study-only POC ultrasound examinations. Indications were 48% abdominal, 26% retroperitoneal, and 24% obstetrical. Nine blinded readers (sonographers, residents, and attending radiologists) sequentially assigned diagnoses to POC and then conventional studies, yielding 476 interpreted study pairs. Diagnostic accuracy was obtained by comparing POC and conventional diagnoses to a reference diagnosis established by the unblinded, senior author. Analysis was stratified by study type, body mass index (BMI), diagnostic confidence, and image quality.
The mean diagnostic accuracy of conventional sonography was 84% compared with 74% for POC (P < .001). This difference was constant regardless of reader, exam type, or BMI. The sensitivity and specificity to detect abnormalities with conventional was 85 and 83%, compared with 75 and 68% for POC. The POC sonography demonstrated greater variability in image quality and diagnostic confidence, and this accounted for lower diagnostic accuracy. When image quality and diagnostic confidence were similar between POC and conventional examinations, there was no difference in accuracy.
Point-of-care was nearly as accurate as conventional sonography for basic, focused examinations. Observed differences in accuracy were attributed to greater variation in POC image quality.
在一般诊断环境中比较手持式即时护理（POC）超声与传统超声检查的诊断准确性，旨在为医疗服务提供者或临床医生在资源有限的环境中合理使用POC超声提供依据。
2010年的3个多月里，在一个学术中心前瞻性纳入了47例患者，以获得54次临床传统超声检查和54次仅用于研究的POC超声检查。检查指征包括48%为腹部检查、26%为腹膜后检查、24%为产科检查。9名不知情的阅片者（超声检查技师、住院医师和放射科主治医师）依次对POC检查结果及随后的传统检查结果进行诊断，共产生476对解读后的检查结果。通过将POC诊断结果和传统诊断结果与由未参与盲法的资深作者确定的参考诊断结果进行比较，得出诊断准确性。分析按研究类型、体重指数（BMI）、诊断置信度和图像质量进行分层。
传统超声检查的平均诊断准确率为84%，而POC超声检查为74%（P < 0.001）。无论阅片者、检查类型或BMI如何，这种差异都是恒定的。传统超声检查检测异常的敏感性和特异性分别为85%和83%，而POC超声检查分别为75%和68%。POC超声检查在图像质量和诊断置信度方面表现出更大的变异性，这导致了较低的诊断准确性。当POC检查和传统检查的图像质量和诊断置信度相似时，准确性没有差异。
对于基本的、有重点的检查，即时护理超声检查的准确性与传统超声检查相近。观察到的准确性差异归因于POC超声图像质量的更大变异性。
