Berg Ingvar, Walpot Kris, Lamprecht Hein, Valois Maxime, Lanctôt Jean-François, Srour Nadim, van den Brand Crispijn
Emergency Medicine Department, Haaglanden Medical Centre, The Hague, NLD.
Emergency Medicine Department, University Hospital Leuven, Leuven, BEL.
Cureus. 2022 Mar 15;14(3):e23188. doi: 10.7759/cureus.23188. eCollection 2022 Mar.
Early identification of the shock type and correct diagnosis is associated with better outcomes. Previous studies have suggested that point-of-care ultrasound (POCUS) increases the diagnostic accuracy of patients in undifferentiated shock. However, a complete overview of the diagnostic accuracy of POCUS and the related treatment changes when compared to standard care is still limited. Our objective was to compare POCUS against standard practice regarding the diagnostic accuracy and specific therapeutic management changes (fluid volume administration and vasopressor use) in patients with undifferentiated shock in the emergency department (ED). We conducted a systematic review in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses. A systematic search was performed using Embase, PubMed, Cochrane Central Register for Controlled Trials, and clinicaltrials.gov. Two physicians independently selected the articles and assessed the quality of the studies independently with the Quadas-2 tool. All included studies used POCUS in adult patients in undifferentiated shock and described diagnostic accuracy or specific therapeutic management changes (fluid volume administration or vasopressor use) and compared this to standard care. The primary outcome was diagnostic accuracy. Secondary outcomes were the amount of fluid administered and vasopressor use in the ED. Only articles published after 1996 were included. There were 10,805 articles found of which 6 articles were included. Four out of six studies reported diagnostic accuracy, three reported on fluid administration and vasopressors. We found that the diagnostic accuracy improved through the use of POCUS when compared to the standard care group, increasing overall diagnostic accuracy from 45-60% to 80-89% when combined with clinical information. There was no significant difference in fluid administration or vasopressor use between the groups. In our systematic review, we found that the use of POCUS in patients that presented with undifferentiated shock in the ED improved the diagnostic accuracy of the shock type and final diagnosis. POCUS resulted in no changes in fluid administration or vasopressor use when compared to standard care. However, the results should be interpreted within the limitations of some of the studies that were included in the review.
早期识别休克类型并进行正确诊断与更好的治疗结果相关。先前的研究表明，床旁超声（POCUS）可提高未分化休克患者的诊断准确性。然而，与标准治疗相比，POCUS诊断准确性及相关治疗变化的完整概述仍然有限。我们的目的是比较POCUS与标准治疗方法在急诊科（ED）未分化休克患者诊断准确性及特定治疗管理变化（液体量输注和血管升压药使用）方面的差异。我们按照系统评价和Meta分析的首选报告项目进行了一项系统评价。使用Embase、PubMed、Cochrane对照试验中央注册库和clinicaltrials.gov进行了系统检索。两名医生独立选择文章，并使用Quadas-2工具独立评估研究质量。所有纳入研究均在未分化休克的成年患者中使用POCUS，并描述了诊断准确性或特定治疗管理变化（液体量输注或血管升压药使用），并将其与标准治疗进行比较。主要结局是诊断准确性。次要结局是急诊科的液体输注量和血管升压药使用情况。仅纳入1996年后发表的文章。共检索到10805篇文章，其中6篇被纳入。六项研究中的四项报告了诊断准确性，三项报告了液体输注和血管升压药使用情况。我们发现，与标准治疗组相比，使用POCUS可提高诊断准确性，结合临床信息时，总体诊断准确性从45%-60%提高到80%-89%。两组在液体输注或血管升压药使用方面无显著差异。在我们的系统评价中，我们发现，在急诊科表现为未分化休克的患者中使用POCUS可提高休克类型和最终诊断的诊断准确性。与标准治疗相比，POCUS在液体输注或血管升压药使用方面没有变化。然而，这些结果应在纳入评价的一些研究的局限性范围内进行解释。
