Becker Torben K, Tafoya Chelsea A, Osei-Ampofo Maxwell, Tafoya Matthew J, Kessler Ross A, Theyyunni Nikhil, Yakubu Hussein A, Opuni Daniel, Clauw Daniel J, Cranford James A, Oppong Chris K, Oteng Rockefeller A
Department of Emergency Medicine, University of Florida, Gainesville, FL, USA.
Department of Emergency Medicine, Highland Hospital, Oakland, CA, USA.
Trop Med Int Health. 2017 Dec;22(12):1599-1608. doi: 10.1111/tmi.12992. Epub 2017 Nov 9.
To assess the effects of a cardiopulmonary ultrasound (CPUS) examination on diagnostic accuracy for critically ill patients in a resource-limited setting.
Approximately half of the emergency medicine resident physicians at the Komfo Anokye Teaching Hospital (KATH) in Kumasi, Ghana, were trained in a CPUS protocol. Adult patients triaged to the resuscitation area of the emergency department (ED) were enrolled if they exhibited signs or symptoms of shock or respiratory distress. Patients were assigned to the intervention group if their treating physician had completed the CPUS training. The physician's initial diagnostic impression was recorded immediately after the history and physical examination in the control group, and after an added CPUS examination in the intervention group. This was compared to a standardised final diagnosis derived from post hoc chart review of the patient's care at 24 h by two blinded, independent reviewers using a clearly defined and systematic process. Secondary outcomes were 24-h mortality and use of IV fluids, diuretics, vasopressors and bronchodilators.
Of 890 patients presenting during the study period, 502 were assessed for eligibility, and 180 patients were enrolled. Diagnostic accuracy was higher for patients who received the CPUS examination (71.9% vs. 57.1%, Δ 14.8% [CI 0.5%, 28.4%]). This effect was particularly pronounced for patients with a 'cardiac' diagnosis, such as cardiogenic shock, congestive heart failure or acute valvular disease (94.7% vs. 40.0%, Δ 54.7% [CI 8.9%, 86.4%]). Secondary outcomes were not different between groups.
In an urban ED in Ghana, a CPUS examination improved the accuracy of the treating physician's initial diagnostic impression. There were no differences in 24-h mortality and a number of patient care interventions.
评估在资源有限的环境下，心肺超声（CPUS）检查对危重症患者诊断准确性的影响。
加纳库马西Komfo Anokye教学医院（KATH）约一半的急诊医学住院医师接受了CPUS检查方案的培训。如果成年患者出现休克或呼吸窘迫的体征或症状，且被分诊到急诊科（ED）的复苏区，则纳入研究。如果患者的主治医生完成了CPUS培训，则将其分配到干预组。在对照组中，医生在病史和体格检查后立即记录其初步诊断印象，而在干预组中，则在额外进行CPUS检查后记录。将其与由两名盲法、独立的评审员使用明确界定的系统流程对患者24小时护理情况进行事后图表审查得出的标准化最终诊断进行比较。次要结局指标为24小时死亡率以及静脉输液、利尿剂、血管升压药和支气管扩张剂的使用情况。
在研究期间就诊的890例患者中，502例接受了资格评估，180例患者被纳入研究。接受CPUS检查的患者诊断准确性更高（71.9%对57.1%，差异14.8%[可信区间0.5%，28.4%]）。对于“心脏”诊断的患者，如心源性休克、充血性心力衰竭或急性瓣膜病，这种效果尤为明显（94.7%对40.0%，差异54.7%[可信区间8.9%，86.4%]）。两组间次要结局指标无差异。
在加纳的一家城市急诊科，CPUS检查提高了主治医生初步诊断印象的准确性。24小时死亡率和多项患者护理干预措施方面没有差异。
