全科医生在基层医疗中进行的床旁肺部超声检查的准确性：一项横断面研究。

Accuracy of point-of-care ultrasound examination of the lung in primary care performed by general practitioners: a cross-sectional study.

作者信息

Halata David, Zhor Dusan, Skulec Roman, Seifert Bohumil

机构信息

Department of Preventive Medicine, Faculty of Medicine in Hradec Kralove, Charles University, Simkova 870, Hradec Kralove, 500 03, Czech Republic.

Working group on ultrasound in primary care, Czech Society of General Practice, Czech Medical Association of Jan Evangelista Purkyne, Sokolska 490/31, 120 00, Prague, Czech Republic.

出版信息

BMC Prim Care. 2025 Apr 8;26(1):99. doi: 10.1186/s12875-025-02802-4.

DOI:10.1186/s12875-025-02802-4

PMID:40200132

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC11978004/

Abstract

BACKGROUND

Lung ultrasonography (LUS) is a point-of-care imaging modality with growing potential in primary care.

OBJECTIVES

While its use is well established in hospital settings, data on its accuracy when performed by general practitioners (GPs) remain limited. This study aimed to assess the diagnostic accuracy of LUS conducted by GPs following structured training.

METHODS

We recruited 17 GPs from various regions of the Czech Republic. They completed a two-day educational course focused on LUS. Patients with current dyspnoea (NYHA II-IV) or a history of dyspnoea within the last four weeks were included and underwent LUS to assess the presence of pleural effusion and interstitial syndrome. An independent expert sonographer, blinded to clinical data, evaluated recorded LUS video loops as the reference standard. LUS findings were categorized into A profile (presence of A lines and intact lung sliding, indicating normal aeration), B profile (three or more B lines per intercostal space in at least two intercostal spaces per hemithorax, suggesting interstitial syndrome), pulmonary consolidation and pleural effusion.

RESULTS

A total of 128 patients were enrolled in the study. A total of 768 thoracic segments were examined. A profile was identified in 642 (83.6%) segments, B profile in 108 (14.1%), pulmonary consolidation in 8 (1.0%), and pleural effusion in 12 (1.6%). For the identification of A profile, the sensitivity was 97.51% (95% CI 95.98-98.57), and the specificity was 88.10% (95% CI 81,13-93,18); for B profile, the sensitivity was 87.04% (95% CI 79,21-92,73), and the specificity was 97.73% (95% CI96,28-98,72); for pulmonary consolidation, the sensitivity was 100.0% (95% CI 63,06-100,00), and the specificity was 100.0% (95% CI 99,52-100,0); for pleural effusion, the sensitivity was 83.33% (95% CI 51,59-97,91), and the specificity was 99.87% (95% CI 99,27-100,00).

CONCLUSION

Our findings provide important preliminary data, demonstrating that GPs can perform LUS accurately after a structured training program. THE TRIAL REGISTRATION IDENTIFIER: is NCT04905719.

摘要

背景

肺部超声检查（LUS）是一种即时床旁成像方式，在初级医疗保健中的潜力日益增长。

目的

虽然其在医院环境中的应用已得到充分证实，但关于全科医生（GPs）进行该检查时的准确性数据仍然有限。本研究旨在评估全科医生在接受结构化培训后进行LUS的诊断准确性。

方法

我们从捷克共和国不同地区招募了17名全科医生。他们完成了为期两天的聚焦于LUS的教育课程。纳入当前有呼吸困难（纽约心脏协会II-IV级）或在过去四周内有呼吸困难病史的患者，并接受LUS检查以评估胸腔积液和间质综合征的存在。一名对临床数据不知情的独立专家超声医师将记录的LUS视频环作为参考标准进行评估。LUS检查结果分为A型（存在A线且肺滑动正常，表明通气正常）、B型（每侧胸腔至少两个肋间间隙中每个肋间间隙有三条或更多B线，提示间质综合征）、肺实变和胸腔积液。

结果

共有128名患者纳入本研究。共检查了768个胸段。642个（83.6%）胸段为A型，108个（14.1%）为B型，8个（1.0%）为肺实变，12个（1.6%）为胸腔积液。对于A型的识别，敏感性为97.51%（95%置信区间95.98-98.57），特异性为88.10%（95%置信区间81.13-93.18）；对于B型，敏感性为87.04%（9%置信区间79.21-92.73），特异性为97.73%（95%置信区间96.28-98.72）；对于肺实变，敏感性为100.0%（95%置信区间63.06-100.00），特异性为100.0%（95%置信区间99.52-100.0）；对于胸腔积液，敏感性为83.33%（95%置信区间51.59-97.91），特异性为99. (95%置信区间99.27-100.00)。