Emergency Department, University Hospital.
Faculté de médecine, Université de Nantes, Nantes.
Eur J Emerg Med. 2021 Aug 1;28(4):306-311. doi: 10.1097/MEJ.0000000000000801.
Early identification of the cause of shock is associated with better prognosis.
The aim of this study was to explore the performances of an ultrasound protocol (echoSHOCK) to diagnose the cause of shock in the emergency department (ED).
DESIGN, SETTINGS AND PARTICIPANTS: This was a prospective study performed in two EDs. Included patients were older than 18 years admitted with shock. After routine workup strategy, the suspected cause of shock and the planned treatment were reported. The echoSHOCK protocol, using only B mode, was then performed. After performing echoSHOCK, the investigator reported the same two items.
echoSHOCK protocol that assessed: compressive pericardial effusion (tamponade), right ventricle dilatation and flattening of the septum, left ventricle dimension and systolic function, indices of hypovolemia.
We defined four different causes for shock (tamponade, acute cor pulmonale, cardiogenic and hypovolemia). The primary endpoint was the degree of agreement of the routine workup and echoSHOCK with an expert panel.
85 patients [mean age of 73 (14) years] were included. Kappa coefficients between routine strategy and echoSHOCK for the cause of shock, with the expert panel were 0.33 (95% CI, 0.26-0.4) and 0.88 (95% CI, 0.83-0.93), respectively. Likewise, for the planned treatment, kappa were 0.21 (95% CI, 0.14-0.28) and 0.9 (95% CI, 0.85-0.94), respectively. The physician's confidence increased from 3.9 (2.1) before echoSHOCK to 9.3 (1.1) after, (P < 0.001).
This study suggested that echoSHOCK significantly increased the ability to determine the cause of undifferentiated shock in the ED.
早期识别休克的病因与更好的预后相关。
本研究旨在探讨超声方案（echoSHOCK）在急诊科（ED）诊断休克病因的性能。
设计、地点和参与者：这是在两家 ED 进行的前瞻性研究。纳入标准为年龄大于 18 岁、因休克而入院的患者。在进行常规检查后，报告休克的疑似病因和计划治疗。然后进行 echoSHOCK 方案，仅使用 B 模式。进行 echoSHOCK 后，研究者报告了相同的两项内容。
echoSHOCK 方案评估：压缩性心包积液（填塞）、右心室扩张和室间隔变平、左心室尺寸和收缩功能、低血容量指数。
我们定义了休克的四种不同病因（填塞、急性肺心病、心源性和低血容量）。主要终点是常规检查和 echoSHOCK 与专家小组的一致性程度。
纳入了 85 名患者[平均年龄为 73（14）岁]。常规策略与 echoSHOCK 对休克病因与专家小组的kappa 系数分别为 0.33（95%CI，0.26-0.4）和 0.88（95%CI，0.83-0.93）。同样，对于计划治疗，kappa 系数分别为 0.21（95%CI，0.14-0.28）和 0.9（95%CI，0.85-0.94）。在进行 echoSHOCK 之前，医生的信心评分为 3.9（2.1），之后增加到 9.3（1.1）（P<0.001）。
本研究表明，echoSHOCK 显著提高了急诊科区分不明原因休克病因的能力。
