Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana.
Department of Internal Medicine, Indiana University School of Medicine, Indianapolis, Indiana; Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana.
J Emerg Med. 2022 Jun;62(6):769-774. doi: 10.1016/j.jemermed.2022.02.003. Epub 2022 May 11.
Focused cardiac ultrasound (FOCUS) is a vital tool to evaluate patients at the bedside, but its use can be limited by patient habitus, sonographer skill, and time to perform the examination.
Our primary goal was to determine the diagnostic accuracy of the parasternal long axis (PSLA) view in isolation for identifying pericardial effusion, left ventricular (LV) dysfunction, and right ventricular (RV) dilatation compared with a four-view FOCUS examination.
This was a retrospective study looking at FOCUS images. Examinations were blinded and randomized for review by point-of-care ultrasound faculty. The primary objective was measured by comparing ultrasound findings on PSLA view in isolation with findings on a full four-view FOCUS examination, which served as the criterion standard. Sensitivity and specificity were calculated.
Of 100 FOCUS examinations; 36% were normal, 16% had a pericardial effusion, 41% had an LV ejection fraction < 50%, and 7% had RV dilatation. Sensitivity and specificity for identifying pericardial effusion, LV dysfunction, and RV dilatation were 81% (confidence interval [CI] 0.54-0.95) and 98% (95% CI 0.91-0.99), 100% (95% CI 0.88-1) and 91% (95% CI 0.80-0.97), and 71% (95% CI 0.30-0.94) and 99% (95% CI 0.93-1), respectively. All moderate to large effusions were identified correctly. Overall, there were only four clinically significant disagreements between PSLA alone and the four-view interpretations.
In isolation, the PSLA view was highly sensitive and specific for identifying LV ejection fraction and moderate to large pericardial effusions. It was highly specific for identifying RV dilatation, but had only moderate sensitivity.
焦点心脏超声（FOCUS）是评估床边患者的重要工具，但由于患者体型、超声医师技能和进行检查的时间等因素的限制，其应用可能受到限制。
我们的主要目标是确定孤立的胸骨旁长轴（PSLA）视图在识别心包积液、左心室（LV）功能障碍和右心室（RV）扩张方面的诊断准确性，与四视图 FOCUS 检查相比。
这是一项回顾性研究，研究对象为 FOCUS 图像。检查结果为盲法和随机分配，由床边超声教师进行审查。主要目标是通过比较 PSLA 视图上的超声结果与完整的四视图 FOCUS 检查结果进行比较来衡量，后者作为标准。计算了敏感性和特异性。
在 100 次 FOCUS 检查中；36%正常，16%有心包积液，41%的左心室射血分数<50%，7%有 RV 扩张。识别心包积液、LV 功能障碍和 RV 扩张的敏感性和特异性分别为 81%（置信区间 [CI] 0.54-0.95）和 98%（95% CI 0.91-0.99）、100%（95% CI 0.88-1）和 91%（95% CI 0.80-0.97），以及 71%（95% CI 0.30-0.94）和 99%（95% CI 0.93-1）。所有中等至大量积液均正确识别。总体而言，PSLA 单独与四视图解释之间只有 4 次具有临床意义的分歧。
孤立的 PSLA 视图在识别 LV 射血分数和中等至大量心包积液方面具有高度的敏感性和特异性。它在识别 RV 扩张方面具有高度特异性，但敏感性仅为中等。
