Ahn Jung Hwan, Jeon Jin, Toh Hong-Chuen, Noble Vicki Elizabeth, Kim Jun Su, Kim Young Sik, Do Han Ho, Ha Young Rock
Department of Emergency Medicine, Ajou University School of Medicine, Suwon, Republic of Korea.
Department of Emergency Medicine, Bundang Jesaeng General Hospital, Sungnam, Republic of Korea.
PLoS One. 2017 Mar 29;12(3):e0174581. doi: 10.1371/journal.pone.0174581. eCollection 2017.
This study was conducted to evaluate a problem-oriented focused torso bedside ultrasound protocol termed "Sonographic Evaluation of Aetiology for Respiratory difficulty, Chest pain, and/or Hypotension" (SEARCH 8Es) for its ability to narrow differential diagnoses and increase physicians' diagnostic confidence, and its diagnostic accuracy, for patients presenting with dyspnea, chest pain, or symptomatic hypotension.
This single-center prospective observational study was conducted over 12 months in an emergency department and included 308 patients (184 men and 124 women; mean age, 67.7 ± 19.1 years) with emergent cardiopulmonary symptoms. The paired t-test was used to compare the number of differential diagnoses and physician's level of confidence before and after SEARCH 8Es. The overall accuracy of the SEARCH 8Es protocol in differentiating 13 diagnostic entities was evaluated based on concordance (kappa coefficient) with the diagnosis made by the inpatient specialists. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated.
SEARCH 8Es narrows the number of differential diagnoses (2.5 ± 1.5 vs. 1.4 ± 0.7; p < 0.001) and improves physicians' diagnostic confidence (2.8 ± 0.8 vs. 4.3 ± 0.9; p < 0.001) significantly. The overall kappa coefficient value was 0.870 (p < 0.001), with the overall sensitivity, specificity, positive predictive value, and negative predictive value at 90.9%, 99.0%, 89.7%, and 99.0%, respectively.
The SEARCH 8Es protocol helps emergency physicians to narrow the differential diagnoses, increase diagnostic confidence and provide accurate assessment of patients with dyspnea, chest pain, or symptomatic hypotension.
本研究旨在评估一种以问题为导向的聚焦躯干床旁超声方案，即“呼吸困难、胸痛和/或低血压病因的超声评估”（SEARCH 8Es），以确定其对伴有呼吸困难、胸痛或症状性低血压的患者缩小鉴别诊断范围、提高医生诊断信心的能力及其诊断准确性。
这项单中心前瞻性观察性研究在急诊科进行了12个月，纳入了308例有紧急心肺症状的患者（184例男性和124例女性；平均年龄67.7±19.1岁）。采用配对t检验比较SEARCH 8Es实施前后的鉴别诊断数量和医生的信心水平。基于与住院专科医生诊断的一致性（kappa系数）评估SEARCH 8Es方案在区分13种诊断实体方面的总体准确性。计算敏感性、特异性、阳性预测值和阴性预测值。
SEARCH 8Es显著缩小了鉴别诊断范围（2.5±1.5对1.4±0.7；p<0.001），并显著提高了医生的诊断信心（2.8±0.8对4.3±0.9；p<0.001）。总体kappa系数值为0.870（p<0.001），总体敏感性、特异性、阳性预测值和阴性预测值分别为90.9%、99.0%、89.7%和99.0%。
SEARCH 8Es方案有助于急诊医生缩小鉴别诊断范围，提高诊断信心，并为伴有呼吸困难、胸痛或症状性低血压的患者提供准确评估。
