社区急诊科中床边超声在胆结石疾病护理中的应用：一种确认偏倚。
The Use of Bedside Ultrasound for Gallstone Disease Care within a Community-based Emergency Department: A Confirmation Bias.
作者信息
Gunther Karin H, Smith Joshua, Boura Judith, Sherman Andrew, Siegel David
机构信息
Ascension Macomb-Oakland Hospital.
Beaumont Hospital.
出版信息
Spartan Med Res J. 2021 Apr 13;6(1):18182. doi: 10.51894/001c.18182.
INTRODUCTION
Traditional evaluation for suspicion of gallstone or gallbladder-related disease includes evaluation with a formal technician-performed ultrasound. However, the use of point-of-care bedside ultrasounds (Bedside US) has been shown to be a viable alternative for the diagnosis of gallstones and gallbladder-related diseases. : The purpose of this study was to evaluate the impact of Bedside US use in gallbladder evaluation on key patient care outcomes within our community-based emergency department setting.
METHODS
This retrospective study compared the use of no ultrasound (No US), a formal technician performed ultrasound (Tech US) and Bedside US for gallstone and gallbladder related diseases within a community hospital emergency department between January 1, 2015 and January 1, 2018. Initial vitals, lab work, patient socio-demographics, medical history, emergency department length of stay in hours and disposition were reviewed.
RESULTS
Of a total N = 449 patients included, patients who received a Bedside US had the fewest computerized tomography scans (No US 62% vs. Tech US 29% vs. Bedside US 16%; p < 0.0001), the shortest median emergency department length of stay (No US 4.5 days vs. Tech US 5.0 days vs. Bedside US 3.0 days; p < 0.0001), and were more likely to be discharged home (No US 41% vs. Tech US 55% vs. Bedside US 81%; p = 0.0006) compared to those that received no ultrasound or a formal ultrasound. Patients who received a Bedside US also had the statistically significant highest incidence of prior cholelithiasis (No US 29.4% vs Tech US 14.3% vs. Bedside US 31.3%; p = 0.001) and lowest total median bilirubin levels (No US 0.5 vs. Tech US 0.5 vs. Bedside US 0.3; p = 0.016) when compared to the other two groups.
CONCLUSIONS
Although there was a confirmation bias, these study results indicate that point-of-care bedside ultrasound could be a viable alternative for gallstones and gallbladder-related diseases with benefits of use in a community hospital setting.
引言
对于疑似胆结石或胆囊相关疾病的传统评估包括由专业技术人员进行的正式超声检查。然而，床旁即时超声检查（Bedside US）已被证明是诊断胆结石和胆囊相关疾病的一种可行替代方法。本研究的目的是评估在我们社区急诊科环境中使用床旁即时超声检查对胆囊评估中关键患者护理结果的影响。
方法
这项回顾性研究比较了2015年1月1日至2018年1月1日期间社区医院急诊科对胆结石和胆囊相关疾病不使用超声检查（No US）、由专业技术人员进行的正式超声检查（Tech US）和床旁即时超声检查（Bedside US）的情况。回顾了初始生命体征、实验室检查结果、患者社会人口统计学特征、病史、急诊科住院时长（以小时为单位）和处置情况。
结果
在纳入的总共N = 449例患者中，接受床旁即时超声检查的患者进行计算机断层扫描的次数最少（不使用超声检查组为62%，专业技术人员进行超声检查组为29%，床旁即时超声检查组为16%；p < 0.0001），急诊科住院中位数最短（不使用超声检查组为4.5天，专业技术人员进行超声检查组为5.0天，床旁即时超声检查组为3.0天；p < 0.0001），并且与未接受超声检查或正式超声检查的患者相比，更有可能出院回家（不使用超声检查组为41%，专业技术人员进行超声检查组为55%，床旁即时超声检查组为81%；p = 0.0006）。与其他两组相比，接受床旁即时超声检查的患者既往胆石症的发生率在统计学上也显著最高（不使用超声检查组为29.4%，专业技术人员进行超声检查组为14.3%，床旁即时超声检查组为31.3%；p = 0.001），总胆红素中位数最低（不使用超声检查组为0.5，专业技术人员进行超声检查组为0.5，床旁即时超声检查组为0.3；p = 0.016）。
结论
尽管存在确认偏倚，但这些研究结果表明，床旁即时超声检查对于胆结石和胆囊相关疾病可能是一种可行的替代方法，在社区医院环境中使用具有优势。
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