床旁超声：与额外的横断面成像的下游利用和诊断（不符）。
Point-of-care ultrasonography: Downstream utilization of and diagnostic (dis)agreements with additional cross-sectional imaging.
机构信息
Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
Medical Imaging Center, Departments of Radiology, Nuclear Medicine and Molecular Imaging, University Medical Center Groningen, University of Groningen, Groningen, the Netherlands.
出版信息
Eur J Radiol. 2022 Jul;152:110344. doi: 10.1016/j.ejrad.2022.110344. Epub 2022 May 5.
OBJECTIVES
Point-of-care ultrasonography (POCUS), defined as ultrasonography (US) performed and interpreted by the clinician, is increasingly performed. This study aimed to determine the frequency of and reasons why clinicians of the emergency department request cross-sectional imaging after POCUS and how often radiologists experience diagnostic (dis)agreements.
METHODS
This retrospective study included a consecutive series of 503 patients who underwent POCUS at the emergency department of a tertiary care center.
RESULTS
Downstream cross-sectional imaging was performed in 77 (15.3%) of 503 POCUS examinations. Reasons for additional cross-sectional imaging were, in order of decreasing frequency: suspicion of pathology that was not assessed with POCUS in 46 cases (59.7%), confirmation of conclusive POCUS findings in 21 cases (27.3%), inconclusive POCUS (i.e. insufficient visualization of the structure of interest to make a diagnosis, despite an attempt of the POCUS operator) in 7 cases (9.6%), a combination of inconclusive POCUS and suspicion of pathology that was not assessed with POCUS in 2 cases (2.6%), and clarification of incidental findings on POCUS in 1 case (1.3%). In the 21 cases that underwent additional cross-sectional imaging to confirm POCUS findings, POCUS agreed with additional cross-sectional imaging in 19 (90.5%) and disagreed in 2 (9.5%) cases.
CONCLUSIONS
The use of POCUS appears to not cause any considerable downstream overutilization of cross-sectional imaging. In addition, radiologists experience few diagnostic disagreements when asked to perform second opinion cross-sectional imaging. Future studies with more homogeneous datasets in terms of POCUS operators are required to confirm our results.
目的
床边超声检查（POCUS）是指由临床医生进行和解读的超声检查，其应用日益广泛。本研究旨在确定急诊科医生在进行 POCUS 后要求进行横断面成像的频率和原因，以及放射科医生经历诊断（不一致）的频率。
方法
这是一项回顾性研究，纳入了在一家三级护理中心急诊科进行 POCUS 的连续 503 例患者。
结果
在 503 次 POCUS 检查中，有 77 次（15.3%）进行了后续的横断面成像。进行额外横断面成像的原因按频率降序排列如下：46 例（59.7%）疑似存在 POCUS 未评估的病变，21 例（27.3%）为明确 POCUS 检查结果，7 例（9.6%）为 POCUS 结果不确定（即尽管 POCUS 操作者进行了尝试，但仍无法观察到感兴趣结构以做出诊断），2 例（2.6%）为 POCUS 结果不确定和疑似存在 POCUS 未评估的病变，1 例（1.3%）为 POCUS 上偶然发现的情况需要进一步明确。在 21 例为明确 POCUS 结果而进行额外横断面成像的病例中，POCUS 与额外横断面成像结果一致的有 19 例（90.5%），不一致的有 2 例（9.5%）。
结论
使用 POCUS 似乎不会导致横断面成像的大量过度使用。此外，放射科医生在进行第二意见横断面成像时很少出现诊断不一致的情况。需要更多在 POCUS 操作者方面具有同质数据集的未来研究来证实我们的结果。
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