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首页> 外文期刊>Western Journal of Emergency Medicine >Point-of-Care Multi-Organ Ultrasound Improves Diagnostic Accuracy in Adults Presenting to the Emergency Department with Acute Dyspnea
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Point-of-Care Multi-Organ Ultrasound Improves Diagnostic Accuracy in Adults Presenting to the Emergency Department with Acute Dyspnea

机译：现场护理多器官超声提高了急诊呼吸急症的成年人的诊断准确性。

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Introduction: Determining the etiology of acute dyspnea in emregency department (ED) patients is often difficult. Point-of-care ultrasound (POCUS) holds promise for improving immediate diagnostic accuracy (after history and physical), thus improving use of focused therapies. We evaluate the impact of a three-part POCUS exam, or “triple scan” (TS) – composed of abbreviated echocardiography, lung ultrasound and inferior vena cava (IVC) collapsibility assessment – on the treating physician’s immediate diagnostic impression. Methods: A convenience sample of adults presenting to our urban academic ED with acute dyspnea (Emergency Severity Index 1, 2) were prospectively enrolled when investigator sonographers were available. The method for performing components of the TS has been previously described in detail. Treating physicians rated the most likely diagnosis after history and physical but before other studies (except electrocardiogram) returned. An investigator then performed TS and disclosed the results, after which most likely diagnosis was reassessed. Final diagnosis (criterion standard) was based on medical record review by expert emergency medicine faculty blinded to TS result. We compared accuracy of pre-TS and post-TS impression (primary outcome) with McNemar’s test. Test characteristics for treating physician impression were also calculated by dichotomizing acute decompensated heart failure (ADHF), chronic obstructive pulmonary disease (COPD) and pneumonia as present or absent. Results: 57 patients were enrolled with the leading final diagnoses being ADHF (26%), COPD/asthma (30%), and pneumonia (28%). Overall accuracy of the treating physician’s impression increased from 53% before TS to 77% after TS (p=0.003). The post-TS impression was 100% sensitive and 84% specific for ADHF. Conclusion: In this small study, POCUS evaluation of the heart, lungs and IVC improved the treating physician’s immediate overall diagnostic accuracy for ADHF, COPD/asthma and pneumonia and was particularly useful to immediately exclude ADHF as the cause of acute dyspnea.
机译：简介：确定急诊科（ED）患者的急性呼吸困难的病因通常很困难。即时护理超声（POCUS）有望提高即时诊断的准确性（在病史和体检之后），从而改善聚焦疗法的使用。我们评估了由三部分组成的POCUS考试或“三重扫描”（TS）（由缩写的超声心动图，肺部超声和下腔静脉（IVC）的可折叠性评估组成）对主治医生的即时诊断印象的影响。方法：前瞻性地选择了在我们的城市学术急诊中出现急性呼吸困难（紧急严重性指数1、2）的成年人作为样本，当时有研究者可以提供超声检查。先前已经详细描述了用于执行TS的组件的方法。在历史和体格检查之后，但在其他研究（心电图除外）返回之前，主治医师对最可能的诊断进行了评分。然后，研究人员进行了TS并披露了结果，之后最有可能的诊断被重新评估。最终诊断（标准）基于对TS结果不了解的专家急诊医学系的病历审查。我们将TS之前和TS之后的印象（主要结果）的准确性与McNemar的测试进行了比较。还通过将急性失代偿性心力衰竭（ADHF），慢性阻塞性肺疾病（COPD）和肺炎（无论存在与否）一分为二，计算出治疗医师印象的测试特征。结果：共有57例患者的最终诊断为ADHF（26％），COPD /哮喘（30％）和肺炎（28％）。治疗医师印象的总体准确性从TS前的53％增加到TS后的77％（p = 0.003）。 TS后的印象对ADHF敏感度为100％，特异性为84％。结论：在这项小型研究中，POCUS对心脏，肺和IVC的评估提高了治疗医师对ADHF，COPD /哮喘和肺炎的即时总体诊断准确性，对于立即排除ADHF作为急性呼吸困难的原因特别有用。

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