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床旁超声对急诊科小肠梗阻诊断和管理的影响:一项回顾性观察性单中心研究

The Impact of Point-of-Care Ultrasound on the Diagnosis and Management of Small Bowel Obstruction in the Emergency Department: A Retrospective Observational Single-Center Study.

作者信息

Di Gioia Carmine Cristiano, Alame Alice, Orso Daniele

机构信息

Department of Emergency Medicine, Community Hospital of Baggiovara (MO), Azienda Ospedaliero-Universitaria di Modena, 41125 Modena, Italy.

Faculty of Medicine and Surgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, 41125 Modena, Italy.

出版信息

Medicina (Kaunas). 2024 Dec 4;60(12):2006. doi: 10.3390/medicina60122006.

Abstract

: Small bowel obstruction (SBO) requires prompt diagnosis and management. Due to its advantages, POCUS can be beneficial when assessing SBO. However, it is still doubtful whether POCUS performed by an emergency doctor can prolong the time of patients with SBO in the emergency department (ED). The primary outcome was time to diagnosis when using POCUS compared to not using it. Secondary outcomes included the processing time in the ED, ED length of stay (LOS), rates of abdominal radiography, hospital LOS, and mortality. : We conducted a retrospective, observational study in our ED from 1 November 2021 to 31 December 2023, including patients aged 18 and older diagnosed with SBO. Both groups received confirmation of their diagnosis through contrast-enhanced computed tomography. The two groups of patients (POCUS group vs. non-POCUS group) were compared regarding the time needed to reach the final diagnosis (i.e., time to diagnosis), the ED LOS, the hospital LOS, and in-hospital mortality. : A total of 106 patients were included. The median time to diagnosis was 121 min for the POCUS group vs. 217 min for the non-POCUS group ( < 0.001). Median ED processing time was 276 min in the POCUS group compared to 376 min in the non-POCUS group ( = 0.006). ED LOS was also shorter in the POCUS group (333 vs. 436 min, = 0.010). Abdominal X-ray rates were lower in the POCUS group (49% vs. 78%, = 0.004). Hospital LOS was similar between the two groups ( = 1.000). Five non-POCUS patients died during hospitalization; none died in the POCUS group, but the difference was not statistically significant ( = 0.063). : POCUS significantly reduced time to diagnosis and ED LOS. Further exploration is needed to assess long-term outcomes and the cost-effectiveness of integrating POCUS into ED practice.

摘要

小肠梗阻(SBO)需要及时诊断和处理。由于其优势,床旁超声(POCUS)在评估SBO时可能有益。然而,急诊医生进行的POCUS是否能延长SBO患者在急诊科(ED)的停留时间仍存在疑问。主要结局是使用POCUS与不使用POCUS时的诊断时间。次要结局包括在ED的处理时间、ED住院时间(LOS)、腹部X线检查率、住院LOS和死亡率。

我们于2021年11月1日至2023年12月31日在我们的ED进行了一项回顾性观察研究,纳入年龄在18岁及以上诊断为SBO的患者。两组均通过对比增强计算机断层扫描确诊。比较两组患者(POCUS组与非POCUS组)达到最终诊断所需的时间(即诊断时间)、ED LOS、住院LOS和住院死亡率。

共纳入106例患者。POCUS组的中位诊断时间为121分钟,而非POCUS组为217分钟(<0.001)。POCUS组的中位ED处理时间为276分钟,而非POCUS组为376分钟(=0.006)。POCUS组的ED LOS也更短(333分钟对436分钟,=0.010)。POCUS组的腹部X线检查率更低(49%对78%,=0.004)。两组的住院LOS相似(=1.000)。5例非POCUS患者在住院期间死亡;POCUS组无死亡病例,但差异无统计学意义(=0.063)。

POCUS显著缩短了诊断时间和ED LOS。需要进一步探索以评估将POCUS纳入ED实践的长期结局和成本效益。

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