Cessford Tara, Meneilly Graydon S, Arishenkoff Shane, Eddy Christopher, Chen Luke Y C, Kim Daniel J, Ma Irene W Y
Departments of Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
Departments of Emergency Medicine, University of British Columbia, Vancouver, British Columbia, Canada.
J Ultrasound Med. 2018 Jul;37(7):1621-1629. doi: 10.1002/jum.14506. Epub 2017 Dec 8.
To determine whether sonographic versions of physical examination techniques can accurately identify splenomegaly, Castell's method (Ann Intern Med 1967; 67:1265-1267), the sonographic Castell's method, spleen tip palpation, and the sonographic spleen tip technique were compared with reference measurements.
Two clinicians trained in bedside sonography patients recruited from an urban hematology clinic. Each patient was examined for splenomegaly using conventional percussion and palpation techniques (Castell's method and spleen tip palpation, respectively), as well as the sonographic versions of these maneuvers (sonographic Castell's method and sonographic spleen tip technique). Results were compared with a reference standard based on professional sonographer measurements.
The sonographic Castell's method had greater sensitivity (91.7% [95% confidence interval, 61.5% to 99.8%]) than the traditional Castell's method (83.3% [95% confidence interval, 51.6% to 97.9%]) but took longer to perform [mean ± SD, 28.8 ± 18.6 versus 18.8 ± 8.1 seconds; P = .01). Palpable and positive sonographic spleen tip results were both 100% specific, but the sonographic spleen tip method was more sensitive (58.3% [95% confidence interval, 27.7% to 84.8%] versus 33.3% [95% confidence interval, 9.9% to 65.1%]).
Sonographic versions of traditional physical examination maneuvers have greater diagnostic accuracy than the physical examination maneuvers from which they are derived but may take longer to perform. We recommend a combination of traditional physical examination and sonographic techniques when evaluating for splenomegaly at the bedside.
确定体格检查技术的超声检查版本能否准确识别脾肿大，将卡斯特尔法（《内科学年鉴》1967年；67:1265 - 1267）、超声卡斯特尔法、脾尖触诊法以及超声脾尖技术与参考测量值进行比较。
从一家城市血液学诊所招募接受过床边超声检查培训的两名临床医生。对每位患者使用传统的叩诊和触诊技术（分别为卡斯特尔法和脾尖触诊法）以及这些操作的超声检查版本（超声卡斯特尔法和超声脾尖技术）检查脾肿大情况。将结果与基于专业超声检查人员测量的参考标准进行比较。
超声卡斯特尔法的灵敏度（91.7% [95%置信区间，61.5%至99.8%]）高于传统卡斯特尔法（83.3% [95%置信区间，51.6%至97.9%]），但执行时间更长[平均值±标准差，28.8±18.6秒对18.8±8.1秒；P = 0.01]。可触及的和超声检查脾尖结果阳性的特异性均为100%，但超声脾尖法更敏感（58.3% [95%置信区间，27.7%至84.8%]对33.3% [95%置信区间，9.9%至65.1%]）。
传统体格检查操作的超声检查版本比其衍生的体格检查操作具有更高的诊断准确性，但可能需要更长时间来执行。我们建议在床边评估脾肿大时结合传统体格检查和超声检查技术。
