Riishede M, Laursen C B, Teglbjærg L S, Rancinger E, Pedersen P B, Luef S M, Clausen J H, Graumann O, Lassen A T, Baatrup G
The Research Section, Department of Surgery (A), Odense University Hospital, Baagoes Allé 15, 5700, Svendborg, Denmark.
Department of Clinical Research, University of Southern Denmark, SDU, Odense, Denmark.
Ultrasound J. 2019 May 27;11(1):11. doi: 10.1186/s13089-019-0126-7.
A fast and diagnostic accurate tool to assess the unselected category of high-acuity patients, in whom the underlying pathology is not always obvious, is needed in the emergency departments (ED). We aim to describe the feasibility, validity and diagnostic yield of a routine whole-body-focused ultrasonography (wbf-us) in an unselected group of high-acuity ED patients.
In a prospective observational study, a convenience sample of ED patients (≥ 18 years) with a high-acuity score or systolic blood pressure < 100 mmHg received a routine wbf-us of the heart, lungs, abdomen and deep veins by two non-expert sonographers. Final diagnosis was established by experienced auditors. Investigators were blinded to the patients' medical history and emergency physicians and auditors were blinded to the investigators assessments. Diagnostic accuracy was assessed by comparing the investigators' ultrasonography findings to a structured double-blinded clinical audit of patient files.
We included 171 patients, initiated a whole-body-focused ultrasonography examination (wbf-us) in 160 and completed it in 128 patients with an average time of a full examination of 28 min. We found pathology in 65/171 (38%) of the patients whose most frequent symptoms upon arrival were cardiopulmonary. Among the patients who received wbf-us, we found the majority of pathology by wbf-us of the lungs (n = 50, 31%), the heart (n = 26, 16%), few in the abdomen (n = 5, 3%) and none in the deep veins. The overall sensitivity was 50-100%, specificity 84-94%, positive predictive value 11-44% and negative predictive value 94-100%.
Focused cardiopulmonary ultrasonography might be considered for routine use in high-acuity ED patients with cardiopulmonary symptoms whereas focused ultrasonography of the abdomen and deep veins performed by non-expert sonographers only seems indicated in selected patients. Trial registration Danish Data Protection Agency (ID 13/12076). Committee on Biomedical Research Ethics for the Region of Southern Denmark (ID S-20130047).
急诊科需要一种快速且诊断准确的工具，用于评估未经过筛选的高 acuity 患者类别，这类患者的潜在病理情况往往并不明显。我们旨在描述常规全身聚焦超声检查（wbf-us）在未经过筛选的高 acuity 急诊科患者群体中的可行性、有效性和诊断率。
在一项前瞻性观察研究中，对高 acuity 评分或收缩压<100 mmHg 的急诊科患者（≥18 岁）进行便利抽样，由两名非专业超声检查人员对其心脏、肺部、腹部和深静脉进行常规 wbf-us 检查。最终诊断由经验丰富的审核人员确定。研究人员对患者的病史不知情，急诊医生和审核人员对研究人员的评估不知情。通过将研究人员的超声检查结果与对患者病历进行的结构化双盲临床审核进行比较，评估诊断准确性。
我们纳入了 171 名患者，对 160 名患者启动了全身聚焦超声检查（wbf-us），其中 128 名患者完成了检查，一次完整检查的平均时间为 28 分钟。我们在 65/171（38%）的患者中发现了病变，这些患者到达时最常见的症状是心肺相关症状。在接受 wbf-us 检查的患者中，我们通过肺部的 wbf-us 发现了大多数病变（n = 50，31%），心脏（n = 26，16%），腹部较少（n = 5，3%），深静脉未发现病变。总体敏感性为 50 - 100%，特异性为 84 - 94%，阳性预测值为 11 - 44%，阴性预测值为 94 - 100%。
对于有心肺症状的高 acuity 急诊科患者，可考虑将聚焦心肺超声检查用于常规检查，而非专业超声检查人员进行的腹部和深静脉聚焦超声检查似乎仅适用于特定患者。试验注册丹麦数据保护局（ID 13/12076）。丹麦南部地区生物医学研究伦理委员会（ID S - 20130047）。
