急诊医学住院医师对疑似心血管疾病患者进行的心脏重点超声检查（FOCUS）。
Focused cardiac ultrasound (FOCUS) by emergency medicine residents in patients with suspected cardiovascular diseases.
作者信息
Farsi Davood, Hajsadeghi Skokoufeh, Hajighanbari Mohammad Javad, Mofidi Mani, Hafezimoghadam Peyman, Rezai Mahdi, Mahshidfar Babak, Abiri Samaneh, Abbasi Saeed
机构信息
Emergency Department, Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran.
Cardiology Department, Iran University of Medical Sciences, Tehran, Iran.
出版信息
J Ultrasound. 2017 May 2;20(2):133-138. doi: 10.1007/s40477-017-0246-5. eCollection 2017 Jun.
INTRODUCTION
Few studies have assessed the value and accuracy of focused cardiac ultrasound (FOCUS) performed by emergency physicians. The aim of the present study was to evaluate the diagnostic accuracy of FOCUS performed by emergency medicine residents compared to echocardiography performed by a cardiologist in emergency department (ED) patients suspected of cardiovascular disease.
METHODS
The research involved a prospective observational cross-sectional study enrolling patients over 18-years old suspected of having cardiovascular disease who required an echocardiograph. For each patient, a FOCUS test was conducted by a trained emergency medicine resident. The diagnostic accuracy of ED performed FOCUS was compared to echocardiography performed by a cardiologist (gold standard) in the ED. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated for FOCUS. The agreement of EM residents and cardiologists on each finding was evaluated using Cohen's kappa coefficient with 95% CI.
RESULTS
Two hundred and five patients, with a mean age of 61.0 ± 17 years (50% male), were included in this study. Agreement between FOCUS performed by an emergency medicine resident and echocardiography performed by a cardiologist in measuring ejection fraction of the left ventricle was 91% ( = 0.85; 95% CI = 0.79-0.91). Reports of the two groups for identifying right ventricular enlargement showed 96% agreement ( = 0.86; 95% CI = 0.82-0.90). The agreements for right ventricular pressure overload, wall motion abnormality and pericardial effusion were 100% ( = 0.83; 95% CI = 0.77-0.89), 92% ( = 0.83; 95% CI = 0.76-0.90), and 96% ( = 0.83; 95% CI = 0.77-0.89), respectively.
CONCLUSION
FOCUS performed by emergency medicine residents is comparable to echocardiography performed by cardiologists. Therefore, it could be a reliable tool and screening test for initial testing of patients suspected of cardiac abnormalities.
引言
很少有研究评估急诊医生进行的心脏聚焦超声（FOCUS）的价值和准确性。本研究的目的是评估急诊科（ED）怀疑患有心血管疾病的患者中，急诊医学住院医师进行的FOCUS与心脏病专家进行的超声心动图检查的诊断准确性。
方法
该研究为前瞻性观察性横断面研究，纳入年龄超过18岁、怀疑患有心血管疾病且需要进行超声心动图检查的患者。对于每位患者，由经过培训的急诊医学住院医师进行FOCUS检查。将急诊科进行的FOCUS的诊断准确性与急诊科心脏病专家进行的超声心动图检查（金标准）进行比较。计算FOCUS的敏感性、特异性、阳性和阴性预测值以及似然比。使用Cohen's kappa系数及95%置信区间评估急诊医学住院医师和心脏病专家在每项检查结果上的一致性。
结果
本研究纳入了205例患者，平均年龄为61.0±17岁（50%为男性）。急诊医学住院医师进行的FOCUS与心脏病专家进行的超声心动图检查在测量左心室射血分数方面的一致性为91%（κ=0.85；95%置信区间=0.79-0.91）。两组在识别右心室扩大方面的报告一致性为96%（κ=0.86；95%置信区间=0.82-0.90）。右心室压力超负荷、室壁运动异常和心包积液的一致性分别为100%（κ=0.83；95%置信区间=0.77-0.89）、92%（κ=0.83；95%置信区间=0.76-0.90）和96%（κ=0.83；95%置信区间=0.77-0.89）。
结论
急诊医学住院医师进行的FOCUS与心脏病专家进行的超声心动图检查相当。因此，它可能是对怀疑有心脏异常的患者进行初步检查的可靠工具和筛查测试。
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