Colclough A, Nihoyannopoulos P
Imperial College Healthcare Trust, St Mary's Hospital, Paddington, London, UK.
Emergency Department, Kings College Hospital, SE5 9RS, Denmark Hill, London, UK.
Herz. 2017 May;42(3):255-261. doi: 10.1007/s00059-016-4531-4.
Acute breathlessness accounts for 8% of accident and emergency attendances. Point-of-care cardiac ultrasound (US) effectively reduces time to diagnosis. Fast and practical information via pocket-sized cardiac US devices may better the diagnosis in this complex patient group.
We prospectively enrolled 40 consecutive patients presenting with shortness of breath at the emergency department (ED). Divided into two groups were all adult patients over 18 with acute breathing difficulties (triage category 1-3): 21 patients received a short focused cardiac US scan using a pocket-sized Vscan and 19 patients received no scan. Data were obtained regarding the time taken for diagnosis and treatment, patient length of stay, inpatient mortality and 30-day mortality.
In the scanned group 33% of patients had significantly abnormal Vscan results that had the potential to aid diagnosis and guide management. The difference of 20 min between the means of the time to diagnosis between the groups was not significant.
The individual knowledge of UK emergency physicians regarding basic echocardiography varies greatly. An intuitive approach following a brief tutorial on pocket-size echocardiography was shown to improve diagnostic accuracy in addition to history taking and physical examination by medical students and junior doctors with no previous exposure to echocardiography. Increasing evidence shows the feasibility and benefit of FOCUS echo in the ED and the pocket-sized devices could play a large role.
The Vscan is a practical, portable device that provides rapid diagnostic information. One third of patients had significant findings on the scans to possibly aid diagnosis and prevent misdiagnosis. This has the potential to reduce time to diagnosis in the ED.
急性呼吸困难占急诊就诊病例的8%。床旁心脏超声检查可有效缩短诊断时间。通过袖珍型心脏超声设备获取快速实用的信息，可能有助于对这一复杂患者群体进行诊断。
我们前瞻性地纳入了40例在急诊科因呼吸急促就诊的连续患者。所有18岁以上有急性呼吸困难的成年患者（分诊类别为1 - 3级）被分为两组：21例患者使用袖珍型Vscan进行了简短的心脏超声重点扫描，19例患者未进行扫描。收集了关于诊断和治疗所需时间、患者住院时间、住院死亡率和30天死亡率的数据。
在扫描组中，33%的患者Vscan结果显著异常，有可能辅助诊断并指导治疗。两组之间诊断时间均值相差20分钟，差异无统计学意义。
英国急诊医生对基本超声心动图的个人知识差异很大。对于之前未接触过超声心动图的医学生和初级医生，在进行简短的袖珍型超声心动图教程培训后，采用直观的方法除了有助于病史采集和体格检查外，还能提高诊断准确性。越来越多的证据表明，急诊床旁超声心动图检查（FOCUS echo）具有可行性和益处，袖珍型设备可能发挥重要作用。
Vscan是一种实用、便携的设备，可提供快速诊断信息。三分之一的患者扫描时有显著发现，可能有助于诊断并防止误诊。这有可能缩短急诊科的诊断时间。
