Arora Samantha, Cheung Angela C, Tarique Usman, Agarwal Arnav, Firdouse Mohammed, Ailon Jonathan
Department of Medicine, McMaster University, Hamilton, ON Canada.
Division of Gastroenterology, Department of Medicine, Toronto Centre for Liver Disease, University Health Network, University of Toronto, Toronto, ON Canada.
J Ultrasound. 2017 Aug 19;20(3):199-204. doi: 10.1007/s40477-017-0261-6. eCollection 2017 Sep.
To compare point-of-care ultrasound and physical examination (PEx), each performed by first-year medical students after brief teaching, for assessing ascites and hepatomegaly. Ultrasound and PEx were compared on: (1) reliability, validity and performance, (2) diagnostic confidence, ease of use, utility, and applicability.
A single-center, randomized controlled trial was performed at a tertiary centre. First-year medical students were randomized to use ultrasound or PEx to assess for ascites and hepatomegaly. Cohen's kappa and interclass coefficient (ICC) were used to measure interrater reliability between trainee assessments and the reference standard (a same day ultrasound by a radiologist). Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were compared. A ten-point Likert scale was used to assess trainee diagnostic confidence and perceptions of utility.
There were no significant differences in interobserver reliability, sensitivity, specificity, accuracy, PPV, or NPV between the ultrasound and PEx groups. However, students in the ultrasound group provided higher scores for perceived utility (ascites 8.38 ± 1.35 vs 7.08 ± 1.86, = 0.008; hepatomegaly 7.68 ± 1.52 vs 5.36 ± 2.48, < 0.001) and likelihood of adoption (ascites 8.67 ± 1.61 vs 7.46 ± 1.79, = 0.02; hepatomegaly 8.12 ± 1.90 vs 5.92 ± 2.32, = 0.001).
When performed by first-year medical students, the validity and reliability of ultrasound is comparable to PEx, but with greater perceived utility and likelihood of adoption. With similarly brief instruction, point-of-care ultrasonography can be as effectively learned and performed as PEx, with a high degree of interest from trainees.
比较在简短教学后由一年级医学生进行的即时超声检查和体格检查（PEx），以评估腹水和肝肿大情况。对超声检查和体格检查在以下方面进行比较：（1）可靠性、有效性和性能，（2）诊断信心、易用性、实用性和适用性。
在一家三级中心进行了一项单中心随机对照试验。一年级医学生被随机分配使用超声或体格检查来评估腹水和肝肿大情况。使用科恩kappa系数和组内相关系数（ICC）来衡量实习医生评估与参考标准（由放射科医生当天进行的超声检查）之间的评分者间可靠性。比较了敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）。使用十点李克特量表来评估实习医生的诊断信心和对实用性的看法。
超声检查组和体格检查组在观察者间可靠性、敏感性、特异性、准确性、PPV或NPV方面没有显著差异。然而，超声检查组的学生在感知实用性（腹水8.38±1.35对7.08±1.86，P = 0.008；肝肿大7.68±1.52对5.36±2.48，P < 0.001）和采用可能性（腹水8.67±1.61对7.46±1.79，P = 0.02；肝肿大8.12±1.90对5.92±2.32，P = 0.001）方面给出了更高的分数。
当由一年级医学生进行时，超声检查的有效性和可靠性与体格检查相当，但具有更高的感知实用性和采用可能性。在接受同样简短的指导后，即时超声检查能够像体格检查一样有效地被学习和操作，并且受到实习生的高度关注。
