Department of Emergency Medicine, Lewis Katz School of Medicine at Temple University, Philadelphia, Pennsylvania, USA.
Department of Emergency Medicine, Winchester Medical Center, Winchester, Virginia, USA.
Acad Emerg Med. 2024 Feb;31(2):112-118. doi: 10.1111/acem.14839. Epub 2023 Dec 19.
An aortic dissection (AoD) is a potentially life-threatening emergency with mortality rates exceeding 50%. While computed tomography angiography remains the diagnostic standard, patients may be too unstable to leave the emergency department. Investigators developed a point-of-care ultrasound (POCUS) protocol combining transthoracic echocardiography (TTE) and the abdominal aorta. The study objective was to determine the test characteristics of this protocol.
This was an institutional review board-approved, multicenter, prospective, observational, cohort study of a convenience sample of adult patients. Patients suspected of having an AoD received a TTE and abdominal aorta POCUS. Three sonographic signs suggested AoD: a pericardial effusion, an intimal flap, or an aortic outflow track diameter measuring more than 35 mm. Investigators present continuous and categorical data as medians with interquartile ranges or proportions with 95% confidence intervals (CIs) and utilized standard 2 × 2 tables on MedCalc (Version 19.1.6) to calculate test characteristics with 95% CI.
Investigators performed 1314 POCUS examinations, diagnosing 21 Stanford type A and 23 Stanford type B AoD. Forty-one of the 44 cases had at least one of the aforementioned sonographic findings. The protocol has a sensitivity of 93.2% (95% CI 81.3-98.6), specificity of 90.9 (95% CI 89.2-92.5), positive and negative predictive values of 26.3% (95% CI 19.6-33.9) and 99.7% (95% CI 99.2-100), respectively, and an accuracy of 91% (95% CI 89.3-92.5).
The SPEED protocol has an overall sensitivity of 93.2% for AoD.
主动脉夹层（AoD）是一种潜在危及生命的紧急情况，死亡率超过 50%。虽然计算机断层血管造影术仍然是诊断标准，但患者可能因不稳定而无法离开急诊室。研究人员开发了一种即时护理超声（POCUS）方案，结合了经胸超声心动图（TTE）和腹主动脉。研究目的是确定该方案的测试特征。
这是一项机构审查委员会批准的多中心、前瞻性、观察性、队列研究，采用便利样本的成年患者。疑似患有 AoD 的患者接受 TTE 和腹主动脉 POCUS 检查。三个超声征象提示 AoD：心包积液、内膜瓣或主动脉流出道直径大于 35mm。研究人员以中位数和四分位距表示连续和分类数据，以比例和 95%置信区间（CI）表示分类数据，并利用 MedCalc（版本 19.1.6）上的标准 2×2 表计算具有 95%CI 的测试特征。
研究人员共进行了 1314 次 POCUS 检查，诊断出 21 例 Stanford 型 A 和 23 例 Stanford 型 B AoD。44 例中有 41 例至少有上述超声发现之一。该方案的灵敏度为 93.2%（95%CI 81.3-98.6），特异性为 90.9%（95%CI 89.2-92.5），阳性预测值和阴性预测值分别为 26.3%（95%CI 19.6-33.9）和 99.7%（95%CI 99.2-100），准确性为 91%（95%CI 89.3-92.5）。
SPEED 方案对 AoD 的总体灵敏度为 93.2%。
