急诊医师施行超声检查对成人急性腹痛患者评估的影响：一项前瞻性随机双中心试验。
Impact of emergency physician performed ultrasound in the evaluation of adult patients with acute abdominal pain: a prospective randomized bicentric trial.
机构信息
Service des urgences, Centre Hospitalier Départemental, La Roche-Yon, France.
Service Des Urgences, Centre Hospitalier Universitaire, 44035, Nantes Cedex 01, France.
出版信息
Scand J Trauma Resusc Emerg Med. 2024 Feb 26;32(1):15. doi: 10.1186/s13049-024-01182-5.
BACKGROUND
Abdominal pain is common in patients visiting the emergency department (ED). The aim of this study was to assess the diagnostic contribution of point-of-care ultrasound (POCUS) in patients presenting to the ED with acute abdominal pain.
METHODS
We designed an interventional randomized, controlled, open label, parallel-group, trial in two French EDs. We included adult patients presenting to the ED with acute abdominal pain. Exclusion criteria were a documented end-of-life, an immediate need of life-support therapy and pregnant or breast-feeding women. Patients were randomized in the experimental group (i.e., workup including POCUS) or control group (usual care). The primary objective of the study was to assess the added value of POCUS on diagnostic pathway in the ED, according to the diagnostic established a posteriori by an adjudication committee. The primary endpoint was the proportion of exact preliminary diagnosis between the 2 groups. The preliminary diagnosis made after clinical examination and biological results with POCUS (intervention arm) or without POCUS (usual care) was considered exact if it was similar to the adjudication committee diagnosis.
RESULTS
Between June 2021 11th and June 2022 23th, 256 patients were randomized, but five were not included in the primary analysis, leaving 125 patients in the POCUS group and 126 patients in the usual care group (130 women and 121 men, median [Q1-Q3] age: 42 [30;57]). There was no difference for exact diagnosis between the two groups (POCUS 70/125, 56% versus control 78/126 (62%), RD 1.23 [95% CI 0.74-2.04]). There was no difference in the accuracy for the diagnosis of non-specific abdominal pain nor number of biological or radiological exams. Diagnostic delays and length of stay in the ED were also similar.
CONCLUSIONS
In this trial, systematic POCUS did not improve the rate of diagnostic accuracy in unselected patients presenting to the ED with acute abdominal pain. However, as it was a safe procedure, further research should focus on patients with suspected etiologies where POCUS is particularly useful.
TRIAL REGISTRATION
This trial was registered on ClinicalTrials.gov on 2022/07/20 ( https://clinicaltrials.gov/study/NCT04912206?id=NCT04912206&rank=1 ) (NCT04912206).
背景
腹痛在急诊科就诊的患者中很常见。本研究旨在评估床边超声（POCUS）在因急性腹痛就诊急诊科的患者中的诊断价值。
方法
我们在法国的两家急诊科设计了一项干预性随机、对照、开放标签、平行组试验。纳入因急性腹痛就诊急诊科的成年患者。排除标准为记录的临终状态、需要立即生命支持治疗和孕妇或哺乳期妇女。患者被随机分配到实验组（即包括 POCUS 的检查）或对照组（常规护理）。研究的主要目的是根据事后由裁决委员会确定的诊断，评估 POCUS 在急诊科诊断路径中的附加价值。主要终点是两组之间精确初步诊断的比例。在临床检查和 POCUS （干预组）或没有 POCUS （常规护理）的生物学结果后做出的初步诊断，如果与裁决委员会的诊断相似，则被认为是准确的。
结果
2021 年 6 月 11 日至 2022 年 6 月 23 日期间，共随机分配了 256 名患者，但有 5 名患者未纳入主要分析，最终 POCUS 组有 125 名患者，常规护理组有 126 名患者（130 名女性和 121 名男性，中位数[Q1-Q3]年龄：42[30；57]）。两组之间的准确诊断无差异（POCUS 组 70/125，56%与对照组 78/126（62%），RD 1.23[95%CI 0.74-2.04]）。非特异性腹痛的诊断准确性和生物或影像学检查的数量也没有差异。诊断延迟和急诊科的住院时间也相似。
结论
在这项试验中，系统的 POCUS 并没有提高在急诊科因急性腹痛就诊的非选择性患者的诊断准确性率。然而，由于这是一种安全的程序，因此进一步的研究应集中在特别有用的疑似病因的患者身上。
试验注册
该试验于 2022 年 7 月 20 日在 ClinicalTrials.gov 上注册（https://clinicaltrials.gov/study/NCT04912206?id=NCT04912206&rank=1）（NCT04912206）。
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