Sisó-Almirall Antoni, Kostov Belchin, Navarro González Marta, Cararach Salami Daniel, Pérez Jiménez Alfonso, Gilabert Solé Rosa, Bru Saumell Concepció, Donoso Bach Lluís, Villalta Martí Mireia, González-de Paz Luis, Ruiz Riera Rafael, Riambau Alonso Vicenç, Acar-Denizli Nihan, Farré Almacellas Marta, Ramos-Casals Manuel, Benavent Àreu Jaume
Consorci d'Atenció Primària de Salut Barcelona Esquerra (CAPSBE), Grup Tranversal de Recerca en Atenció Primària, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
Servei de Radiodiagnòstic, Centre de Diagnòstic per la Imatge, Hospital Clínic de Barcelona, IDIBAPS, Universitat de Barcelona, Barcelona, Spain.
PLoS One. 2017 Apr 28;12(4):e0176877. doi: 10.1371/journal.pone.0176877. eCollection 2017.
We determined the feasibility of abdominal aortic aneurysm (AAA) screening program led by family physicians in public primary healthcare setting using hand-held ultrasound device. The potential study population was 11,214 men aged ≥ 60 years attended by three urban, public primary healthcare centers. Participants were recruited by randomly-selected telephone calls. Ultrasound examinations were performed by four trained family physicians with a hand-held ultrasound device (Vscan®). AAA observed were verified by confirmatory imaging using standard ultrasound or computed tomography. Cardiovascular risk factors were determined. The prevalence of AAA was computed as the sum of previously-known aneurysms, aneurysms detected by the screening program and model-based estimated undiagnosed aneurysms. We screened 1,010 men, with mean age of 71.3 (SD 6.9) years; 995 (98.5%) men had normal aortas and 15 (1.5%) had AAA on Vscan®. Eleven out of 14 AAA-cases (78.6%) had AAA on confirmatory imaging (one patient died). The total prevalence of AAA was 2.49% (95%CI 2.20 to 2.78). The median aortic diameter at diagnosis was 3.5 cm in screened patients and 4.7 cm (p<0.001) in patients in whom AAA was diagnosed incidentally. Multivariate logistic regression analysis identified coronary heart disease (OR = 4.6, 95%CI 1.3 to 15.9) as the independent factor with the highest odds ratio. A screening program led by trained family physicians using hand-held ultrasound was a feasible, safe and reliable tool for the early detection of AAA.
我们确定了在公共基层医疗环境中，由家庭医生使用手持式超声设备开展腹主动脉瘤（AAA）筛查项目的可行性。潜在研究人群为三家城市公共基层医疗中心接诊的11214名年龄≥60岁的男性。通过随机拨打电话招募参与者。由四名经过培训的家庭医生使用手持式超声设备（Vscan®）进行超声检查。观察到的AAA通过标准超声或计算机断层扫描的确认性成像进行验证。确定心血管危险因素。AAA的患病率通过已知动脉瘤、筛查项目检测出的动脉瘤以及基于模型估计的未诊断动脉瘤之和来计算。我们筛查了1010名男性，平均年龄为71.3（标准差6.9）岁；995名（98.5%）男性主动脉正常，15名（1.5%）在Vscan®检查中发现有AAA。14例AAA病例中有11例（78.6%）在确认性成像中显示有AAA（1例患者死亡）。AAA的总患病率为2.49%（95%置信区间2.20至2.78）。筛查出的患者诊断时主动脉直径中位数为3.5 cm，而偶然诊断出AAA的患者为4.7 cm（p<0.001）。多变量逻辑回归分析确定冠心病（比值比=4.6，95%置信区间1.3至15.9）是比值比最高的独立因素。由经过培训的家庭医生使用手持式超声开展的筛查项目是早期检测AAA的一种可行、安全且可靠的工具。
