Pouryahya Pourya, McR Meyer Alastair D, Koo Mei Ping Melody
Emergency Department, Program of Emergency Medicine, Monash Health Casey Hospital Berwick Victoria 3806 Australia.
School of Clinical Sciences at Monash Health Monash Emergency Research Collaborative Monash University Clayton Victoria Australia.
Australas J Ultrasound Med. 2019 Jun 27;22(4):273-278. doi: 10.1002/ajum.12172. eCollection 2019 Nov.
An observational study on the current diagnostic and procedural utility, as well as impact of point-of-care ultrasound (POCUS) in the emergency department (ED).
Point-of-care ultrasound (POCUS) has been recognised as a useful non-invasive bedside tool in providing valuable information, as well as its utility in procedural guidance for clinicians. However, its current prevalence and utility in ED remain unknown.
In October 2016, a 31-day prospective observational study was performed in three Monash Health Emergency Departments in Melbourne, Australia. Data regarding patients' presenting complaints, frequency, operators' qualifications and POCUS module were collected and analysed. Factors associated with diagnostic impacts were identified.
A total of 390 (2.1%) POCUS examinations were performed among 18,355 presentations in the three Monash Health EDs during the study period. POCUS was performed as a diagnostic tool in 344 (88.2%) and procedural guidance in 46 (11.8%) cases. eFAST/AAA and bedside echocardiography were the two most frequently utilised diagnostic modules. Overall, the majority of diagnostic POCUS cases were indicated for abdominal pain (35.3%), chest pain (14.0%) and trauma mainly traffic accidents (5.8%). Procedural POCUS was most commonly used for vascular access (71.7%), where dyspnoea (21.6%) was the most common presenting complaint. The majority of the cases were performed by FACEMs (Fellows of Australasian College of Emergency Medicine) (66.4%).
Despite known diagnostic and procedural values, the prevalence of POCUS in ED was found to be lower than what was expected. The prevalence was shown to be proportional to the level of clinical expertise among the operators. Training and utility of POCUS among physicians and trainees should be further advocated and supported.
一项关于即时超声检查（POCUS）在急诊科（ED）当前的诊断及操作效用以及影响的观察性研究。
即时超声检查（POCUS）已被公认为一种有用的非侵入性床边工具，可提供有价值的信息，并且在为临床医生提供操作指导方面也很有用。然而，其目前在急诊科的普及程度和效用仍不明确。
2016年10月，在澳大利亚墨尔本的三个莫纳什健康急诊科进行了一项为期31天的前瞻性观察性研究。收集并分析了有关患者就诊主诉、频率、操作者资质和POCUS模块的数据。确定了与诊断影响相关的因素。
在研究期间，三个莫纳什健康急诊科的18355例就诊患者中，共进行了390次（2.1%）POCUS检查。POCUS作为诊断工具使用了344次（88.2%），作为操作指导使用了46次（11.8%）。扩展创伤重点超声检查/腹主动脉瘤检查（eFAST/AAA）和床边超声心动图是两个最常用的诊断模块。总体而言，大多数诊断性POCUS病例的指征为腹痛（35.3%）、胸痛（14.0%）和创伤（主要是交通事故，5.8%）。操作POCUS最常用于血管通路（71.7%），其中呼吸困难（占21.6%）是最常见的就诊主诉。大多数病例由澳大利亚急诊医学学院院士（FACEMs）进行（66.4%）。
尽管已知POCUS具有诊断和操作价值，但发现其在急诊科的普及程度低于预期。其普及程度与操作者的临床专业水平成正比。应进一步倡导和支持在医生和实习生中开展POCUS培训及应用。
