First-year medical students use of ultrasound or physical examination to diagnose hepatomegaly and ascites: a randomized controlled trial
First-year medical students use of ultrasound or physical examination to diagnose hepatomegaly and ascites: a randomized controlled trial
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DOI：
10.1007/s40477-017-0261-6
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发表时间：
2017-09-01
影响因子：
2
通讯作者：
Ailon, Jonathan
中科院分区：
文献类型：
--
作者：
Arora, Samantha;Cheung, Angela C.;Ailon, Jonathan
比较床旁超声和体格检查（PEx），每一个都由一年级医学生在简短的教学后进行，以评估腹水和肝肿大。超声和PEx在以下方面进行了比较：（1）可靠性，有效性和性能，（2）诊断信心，易用性，实用性和适用性。一年级的医学生被随机分配使用超声或PEX来评估腹水和肝肿大。科恩的kappa和类间系数（ICC）被用来衡量学员评估和参考标准（同一天的超声由放射科医生）之间的评价者间的可靠性。比较敏感性、特异性、准确性、阳性预测值（PPV）和阴性预测值（NPV）。采用10点Likert量表评估受训者诊断信心和效用感知，超声组和PEx组之间的观察者间可靠性、敏感性、特异性、准确性、PPV或NPV无显著差异。然而，超声波组的学生在感知效用方面得分更高（腹水8.38 ± 1.35 vs 7.08 ± 1.86，p = 0.008;肝肿大7.68 +/- 1.52 vs 5.36 +/- 2.48，p < 0.001）和收养可能性（腹水8.67 ± 1.61 vs 7.46 ± 1.79，p = 0.02;肝肿大8.12 +/- 1.90 vs 5.92 +/- 2.32，p = 0.001）。当由一年级医学生进行时，超声的有效性和可靠性与PEX相当，但具有更大的感知效用和采用的可能性。通过类似的简短指导，床旁超声检查可以像PEx一样有效地学习和执行，并引起学员的高度兴趣。
To compare point-of-care ultrasound and physical examination (PEx), each performed by first-year medical students after brief teaching, for assessing ascites and hepatomegaly. Ultrasound and PEx were compared on: (1) reliability, validity and performance, (2) diagnostic confidence, ease of use, utility, and applicability.A single-center, randomized controlled trial was performed at a tertiary centre. First-year medical students were randomized to use ultrasound or PEx to assess for ascites and hepatomegaly. Cohen's kappa and interclass coefficient (ICC) were used to measure interrater reliability between trainee assessments and the reference standard (a same day ultrasound by a radiologist). Sensitivity, specificity, accuracy, positive predictive value (PPV), and negative predictive value (NPV) were compared. A ten-point Likert scale was used to assess trainee diagnostic confidence and perceptions of utility.There were no significant differences in interobserver reliability, sensitivity, specificity, accuracy, PPV, or NPV between the ultrasound and PEx groups. However, students in the ultrasound group provided higher scores for perceived utility (ascites 8.38 +/- 1.35 vs 7.08 +/- 1.86, p = 0.008; hepatomegaly 7.68 +/- 1.52 vs 5.36 +/- 2.48, p < 0.001) and likelihood of adoption (ascites 8.67 +/- 1.61 vs 7.46 +/- 1.79, p = 0.02; hepatomegaly 8.12 +/- 1.90 vs 5.92 +/- 2.32, p = 0.001).When performed by first-year medical students, the validity and reliability of ultrasound is comparable to PEx, but with greater perceived utility and likelihood of adoption. With similarly brief instruction, point-of-care ultrasonography can be as effectively learned and performed as PEx, with a high degree of interest from trainees.