Departments of Pediatrics and Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Medical Center and New York-Presbyterian Morgan Stanley Children's Hospital, New York, NY.
Departments of Emergency Medicine and Pediatrics, Section of Pediatric Emergency Medicine, Brown University, Providence, RI; Department of Health Services, Policy, and Practice, School of Public Health, Brown University, Providence, RI.
Ann Emerg Med. 2018 Nov;72(5):571-580. doi: 10.1016/j.annemergmed.2018.04.010. Epub 2018 Jul 3.
Radiology-performed transabdominal pelvic ultrasound, used to evaluate female patients with suspected pelvic pathology in the pediatric emergency department (ED), is often delayed by the need to fill the bladder. We seek to determine whether point-of-care ultrasound assessment of bladder fullness can predict patient readiness for transabdominal pelvic ultrasound more quickly than patient sensation of bladder fullness.
We performed a randomized controlled trial of female patients aged 8 to 18 years who required transabdominal pelvic ultrasound in a pediatric ED. Patients were randomized to usual care or point-of-care ultrasound and then assessed every 30 minutes for subjective bladder fullness (0 to 4 ordinal scale) and qualitative bladder fullness by point-of-care ultrasound. Patients were sent for pelvic ultrasound when they reported 3 or 4 on the subjective fullness scale (usual care) or a large bladder was visualized (point-of-care ultrasound). Primary outcome was time from enrollment to completion of pelvic ultrasound. Secondary outcome was success rate of pelvic ultrasound on first attempt.
One hundred twenty patients were randomized and 117 had complete outcomes (59 usual care, 58 point-of-care ultrasound). Kaplan-Meier curves differed between groups (P<.001). Median time to successful completion of pelvic ultrasound was 139 minutes (usual care) and 87.5 minutes (point-of-care ultrasound), with difference in medians 51.5 minutes (95% confidence interval [CI] 23.4 to 77.2 minutes). All point-of-care ultrasound patients had successful transabdominal pelvic ultrasound on the first attempt compared with 84.7% in the usual care group, with difference -15.3% (95% Bayesian credible interval -5.3% to -25.0%). Weighted κ for interrater agreement was 0.83 (95% CI 0.79 to 0.87).
Point-of-care ultrasound assessment of bladder fullness decreases time to transabdominal pelvic ultrasound and improves first-attempt success rate for female patients in the pediatric ED.
放射科进行的经腹部盆腔超声检查，用于评估儿科急诊部（ED）中疑似盆腔疾病的女性患者，通常因需要充盈膀胱而延迟。我们旨在确定床边超声评估膀胱充盈程度是否比患者的膀胱充盈感更快地预测患者是否准备好进行经腹部盆腔超声检查。
我们对需要在儿科 ED 进行经腹部盆腔超声检查的 8 至 18 岁女性患者进行了一项随机对照试验。患者随机分为常规护理或床边超声组，然后每 30 分钟评估一次主观膀胱充盈程度（0 至 4 级）和床边超声的膀胱充盈程度。当患者报告主观充盈量表上的 3 或 4 时（常规护理）或看到大膀胱时（床边超声），将患者送去进行盆腔超声检查。主要结局是从入组到完成盆腔超声检查的时间。次要结局是首次尝试进行盆腔超声检查的成功率。
共有 120 名患者随机分组，117 名患者完成了全部结局（59 名常规护理，58 名床边超声）。两组之间的 Kaplan-Meier 曲线不同（P<.001）。成功完成盆腔超声检查的中位时间为 139 分钟（常规护理）和 87.5 分钟（床边超声），中位数差异为 51.5 分钟（95%置信区间 [CI] 23.4 至 77.2 分钟）。所有床边超声患者均首次成功进行了经腹部盆腔超声检查，而常规护理组的成功率为 84.7%，差异为 -15.3%（95%贝叶斯可信区间 -5.3%至 -25.0%）。两位评分者之间的加权κ 值为 0.83（95% CI 0.79 至 0.87）。
床边超声评估膀胱充盈程度可缩短经腹部盆腔超声检查的时间，并提高儿科 ED 中女性患者首次尝试的成功率。
