舌下微循环的快速临床评估-微 VAS 视觉评分与标准半自动分析的比较。

Rapid clinical assessment of the sublingual microcirculation - Visual scoring using microVAS in comparison to standard semi-automated analysis.

机构信息

Department of Anesthesia, Pain Management and Perioperative Management Dalhousie University, Halifax, NS, Canada.

出版信息

Clin Hemorheol Microcirc. 2019;72(3):229-238. doi: 10.3233/CH-180427.

DOI:10.3233/CH-180427

PMID:30320559

Abstract

RATIONALE

Alterations in human microcirculation occur in many disease states leading to morbidity and mortality, however assessing the microcirculation is not standard clinical practice. Standard microcirculation analysis using semi-automated analysis is expensive, time consuming, and expertise dependent making it unfeasible. We proposed a novel visual scoring system (microVAS) for the analysis of microcirculation videos that can be performed at the patient bedside in real time.

OBJECTIVE

Validate our microVAS score by training health professionals unfamiliar with the microcirculation field to use our microVAS score and compare their scores to the standard method of semi-automated analysis using AVA3 software.

METHODS

Using a prospective double-blind study design, we recruited and trained 20 participants to use our microVAS score. Participants scored 40 videos (from 22 healthy and 18 septic patients) for MFI and PPV. The same 40 videos were analysed by an expert using the gold standard semi-automated method of analysis. The results of the participants and the expert were analysed by Pearson's linear regression. Krippendorff's alpha was used to assess inter-rater reliability of the participants.

RESULTS

Overall correlation of MFI was r = 0.33 (95% CI 0.27-0.39), p < 0.05; overall correlation of PPV was r = -0.11 (95% CI -0.18 to -0.04), p < 0.05. The Krippendorff's alpha for MFI was 0.56 (healthy videos: α= 0.34, sepsis videos: α= 0.31). For PPV Krippendorff's alpha was 0.43 (healthy videos: α= 0.56, sepsis videos: α= 0.17).

CONCLUSIONS

Overall for both MFI and PPV, there was a small correlation between our microVAS score and AVA 3 scores. Regarding inter-rater reliability both MFI and PPV showed fair agreement between raters. Going forward multiple improvements to the microVAS scoring system as well as the training program are suggested to improve reliability and consistency.

摘要

背景

人体微循环的改变发生在许多疾病状态下，导致发病率和死亡率，但评估微循环不是标准的临床实践。使用半自动分析的标准微循环分析既昂贵、耗时，又依赖专业知识，因此不可行。我们提出了一种新的微循环视频分析的可视化评分系统（microVAS），可以在患者床边实时进行。

目的

通过培训不熟悉微循环领域的卫生专业人员使用我们的 microVAS 评分，并将他们的评分与使用 AVA3 软件的半自动分析的标准方法进行比较，验证我们的 microVAS 评分。

方法

采用前瞻性双盲研究设计，我们招募并培训了 20 名参与者使用我们的 microVAS 评分。参与者对 40 个视频（来自 22 个健康和 18 个脓毒症患者）的 MFI 和 PPV 进行评分。同 40 个视频由专家使用黄金标准半自动分析方法进行分析。参与者和专家的结果通过 Pearson 线性回归进行分析。Krippendorff 的 alpha 用于评估参与者的评分者间信度。

结果

MFI 的总体相关性为 r=0.33（95%CI 0.27-0.39），p<0.05；PPV 的总体相关性为 r=-0.11（95%CI -0.18 至-0.04），p<0.05。MFI 的 Krippendorff 的 alpha 为 0.56（健康视频：α=0.34，脓毒症视频：α=0.31）。对于 PPV，Krippendorff 的 alpha 为 0.43（健康视频：α=0.56，脓毒症视频：α=0.17）。