Renberg Mårten, Kilhamn Naima, Lund Kent, Hertzberg Daniel, Rimes-Stigare Claire, Bell Max
Department of Perioperative Medicine and Intensive Care, Karolinska University Hospital, Solna, 171 76, Stockholm, Sweden.
Department of Physiology and Pharmacology, Karolinska Institutet, Stockholm, Sweden.
Ultrasound J. 2020 May 20;12(1):28. doi: 10.1186/s13089-020-00175-6.
The Doppler-derived renal resistive index (RRI) is emerging as a promising bedside tool for assessing renal perfusion and risk of developing acute kidney injury in critically ill patients. It is not known what level of ultrasonography competence is needed to obtain reliable RRI values.
The aim of this study was to evaluate the feasibility of RRI measurements by an intermediate and novice sonographer in a volunteer population.
After a focused teaching session, an intermediate (resident), novice (medical student) and expert sonographer performed RRI measurements in 23 volunteers consecutively and blinded to the results of one another. Intraclass correlation coefficients and Bland-Altman plots were used to evaluate interobserver reliability, bias and precision.
Both non-experts were able to obtain RRI values in all volunteers. Median RRI in the population measured by the expert was 0.58 (interquartile range 0.52-0.62). The intraclass correlation coefficient was 0.96 (95% confidence interval 0.90-0.98) for the intermediate and expert, and 0.85 (95% confidence interval 0.69-0.94) for the novice and expert. In relation to the measurements of the expert, both non-experts showed negligible bias (mean difference 0.002 [95% confidence interval - 0.005 to 0.009, p = 0.597] between intermediate and expert, mean difference 0.002 [95% confidence interval - 0.011 to 0.015, p = 0.752] between novice and expert) and clinically acceptable precision (95% limits of agreement - 0.031 to 0.035 for the intermediate, 95% limits of agreement - 0.056 to 0.060 for the novice).
RRI measurements by both an intermediate and novice sonographer in a volunteer population were reliable, accurate and precise after a brief course. RRI is easy to learn and feasible within the scope of point-of-care ultrasound.
经多普勒衍生的肾阻力指数（RRI）正逐渐成为一种有前景的床旁工具，用于评估危重症患者的肾灌注及发生急性肾损伤的风险。目前尚不清楚获得可靠的RRI值需要何种水平的超声检查能力。
本研究旨在评估中级和新手超声检查医师在志愿者群体中测量RRI的可行性。
经过一次集中教学后，一名中级（住院医师）、新手（医学生）和专家级超声检查医师对23名志愿者连续进行RRI测量，且彼此对结果不知情。组内相关系数和Bland-Altman图用于评估观察者间的可靠性、偏差和精密度。
两名非专家均能够在所有志愿者中获得RRI值。专家测量的人群中RRI中位数为0.58（四分位间距0.52 - 0.62）。中级与专家之间的组内相关系数为0.96（95%置信区间0.90 - 0.98），新手与专家之间为0.85（95%置信区间0.69 - 0.94）。与专家的测量结果相比，两名非专家的偏差均可忽略不计（中级与专家之间的平均差异为0.002 [95%置信区间 - 0.005至0.009，p = 0.597]，新手与专家之间的平均差异为0.002 [95%置信区间 - 0.011至0.015，p = 0.752]），且具有临床可接受的精密度（中级的95%一致性界限为 - 0.031至0.035，新手的95%一致性界限为 - 0.056至0.060）。
经过简短课程培训后，中级和新手超声检查医师在志愿者群体中进行的RRI测量可靠、准确且精密。RRI易于学习，在床旁超声检查范围内可行。
