Nixon Garry, Blattner Katharina, Muirhead Jill, Kerse Ngaire
Dunedin School of Medicine, University of Otago Dunedin, New Zealand.
School of Population Health, University of Auckland, Tamaki, Auckland, New Zealand.
J Prim Health Care. 2018 Dec;10(4):324-330. doi: 10.1071/HC18034.
INTRODUCTION Point-of-care ultrasound (POCUS) of the kidney and bladder are among the most commonly performed POCUS scans in rural New Zealand (NZ). AIM To determine the quality, safety and effect on patient care of POCUS of the kidney and bladder in rural NZ. METHODS Overall, 28 doctors in six NZ rural hospitals completed a questionnaire both before and after undertaking a POCUS scan over a 9-month period. The clinical records and saved ultrasound images were reviewed by a specialist panel. RESULTS The 28 participating doctors undertook 138 kidney and 60 bladder scans during the study. POCUS of the bladder as a test for urinary retention had a sensitivity of 100% (95% CI 88-100) and specificity of 100% (95% CI 93-100). POCUS of the kidney as a test for hydronephrosis had a sensitivity 90% (95% CI 74-96) and specificity of 96% (95% CI 89-98). The accuracy of other findings such as renal stones and bladder clot was lower. POCUS of the bladder appeared to have made a positive contribution to patient care in 92% of cases without evidence of harm. POCUS of the kidney benefited 93% of cases, although in three cases (2%), it may have had a negative effect on patient care. DISCUSSION POCUS as a test for urinary retention and hydronephrosis in the hands of rural doctors was technically straightforward, improved diagnostic certainty, increased discharges and overall had a positive effect on patient care.
引言 肾脏和膀胱的床旁超声检查（POCUS）是新西兰农村地区最常进行的POCUS扫描项目。目的 确定新西兰农村地区肾脏和膀胱POCUS检查的质量、安全性及其对患者护理的影响。方法 总体而言，新西兰六家农村医院的28名医生在9个月的时间里，在进行POCUS扫描前后均完成了一份调查问卷。临床记录和保存的超声图像由一个专家小组进行审查。结果 在研究期间，28名参与的医生进行了138次肾脏扫描和60次膀胱扫描。膀胱POCUS作为尿潴留检测方法的敏感性为100%（95%置信区间88 - 100），特异性为100%（95%置信区间93 - 100）。肾脏POCUS作为肾积水检测方法的敏感性为90%（95%置信区间74 - 96），特异性为96%（95%置信区间89 - 98）。其他发现如肾结石和膀胱血凝块的准确性较低。膀胱POCUS在92%的病例中似乎对患者护理有积极贡献，且无伤害证据。肾脏POCUS使93%的病例受益，不过在3例（2%）中，它可能对患者护理有负面影响。讨论 在农村医生手中，POCUS作为尿潴留和肾积水的检测方法在技术上很简单，提高了诊断的确定性，增加了出院人数，总体上对患者护理有积极影响。
