Division of Cardiology, University of Washington, Seattle, Washington.
Division of Cardiology, University of Washington, Seattle, Washington.
J Am Soc Echocardiogr. 2017 Dec;30(12):1234-1238. doi: 10.1016/j.echo.2017.07.014. Epub 2017 Sep 1.
Echocardiograms are often obtained after business hours on an urgent or emergent basis to assist in the care of patients with complex presentations. Considerable variation exists among academic medical centers with regard to who performs and interprets these studies, with different levels of cardiology fellow involvement in scanning and/or interpreting. On-call echocardiographic interpretation can be educationally valuable for cardiologists in training but may come at the expense of patient care. The aim of this study was to examine the agreement of preliminary fellows' interpretations of weekend on-call transthoracic echocardiograms with official attending cardiologists' interpretations.
Cardiology fellows perform preliminary interpretations of sonographer-obtained echocardiograms obtained on weekends, with final reports performed by attending cardiologists the following business day. In this study, 358 consecutive echocardiograms obtained on weekends over a 12-month period were reviewed. Discrepancies between the preliminary and final interpretations were categorized as either major (diagnoses with implications for urgent change in management) or minor (diagnoses without such implications). All discrepancies were also categorized as a missed diagnosis, an overcall (of severity), or an undercall.
No preliminary interpretation was identified in 18.4% of the studies (66 of 358). Of the remaining on-call echocardiograms (n = 292), the overall discrepancy rate in interpretations between fellows and attending cardiologists was 16.8%. Out of these, the minor discrepancy rate was 14.4% (42 of 292), and the major discrepancy rate was 2.4% (seven of 292). Misses, overcalls, and undercalls accounted for 29%, 31%, and 40% of all discrepancies, respectively.
The results indicate that although minor discrepancies between fellows' and attending cardiologists' interpretations were common (14.4%), major discrepancies were uncommon (2.4%) and similar to major discrepancy rates from the radiology literature. In general, discrepant interpretations were more likely to result from changes in severity, but misses accounted for almost all of the major discrepancies. Further research is needed to compare the clinical impact of different models of on-call echocardiographic services.
为协助诊治临床表现复杂的患者，在非工作时间紧急或紧急情况下通常会获取超声心动图。不同学术医疗中心在执行和解释这些研究方面存在很大差异，不同级别的心脏病学住院医师参与扫描和/或解释的程度也不同。值班时进行超声心动图解读对培训中的心脏病医师具有教育意义，但可能会以牺牲患者护理为代价。本研究旨在检查初级研究员周末值班经胸超声心动图初步解读结果与主治心脏病医师正式解读结果的一致性。
心脏病住院医师对周末由超声技师获取的超声心动图进行初步解读，最终报告由主治心脏病医师在次日工作时间出具。在这项研究中，回顾了 12 个月内周末获得的 358 份连续超声心动图。初步和最终解读之间的差异分为主要差异（有改变紧急处理的诊断）和次要差异（无此影响的诊断）。所有差异也分为漏诊、过诊（严重程度）或漏诊。
18.4%（358 例中有 66 例）的研究中未发现初步解读。在其余的值班超声心动图（n=292）中，住院医师和主治心脏病医师之间的解读总体差异率为 16.8%。其中，次要差异率为 14.4%（292 例中有 42 例），主要差异率为 2.4%（292 例中有 7 例）。漏诊、过诊和漏诊分别占所有差异的 29%、31%和 40%。
结果表明，尽管住院医师和主治心脏病医师之间的次要解读差异很常见（14.4%），但主要差异并不常见（2.4%），与放射学文献中的主要差异率相似。一般来说，不一致的解读更可能是由于严重程度的变化，但主要差异几乎都是漏诊造成的。需要进一步研究比较不同模式的值班超声心动图服务的临床影响。
