Accuracy of Resident-Performed Point-of-Care Lung Ultrasound Examinations Versus Chest Radiography in Pneumothorax Follow-up After Tube Thoracostomy in Rwanda.
Accuracy of Resident-Performed Point-of-Care Lung Ultrasound Examinations Versus Chest Radiography in Pneumothorax Follow-up After Tube Thoracostomy in Rwanda.
复制标题
卢旺达插管胸腔造口术后气胸随访中住院医师进行的护理点肺部超声检查与胸部 X 光检查的准确性。
DOI：
10.1002/jum.15126
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发表时间：
2020
期刊：
影响因子：
--
通讯作者：
Henwood,PatriciaC
中科院分区：
文献类型：
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作者：
Shumbusho,JeanPaul;Duanmu,Youyou;Kim,SungH;Bassett,IngridV;Boyer,EdwardW;Ruutiainen,AlexanderT;Riviello,Robert;Ntirenganya,Faustin;Henwood,PatriciaC
ObjectivesThe aim of this study was to evaluate the accuracy and timidity of resident-performed point-of-care lung ultrasound（LUS）examinations for follow-up of pneumothorax（PTX）after tube thoracostomy.MethodsAfter brief training，Rwanda surgical residents blinded to chest radiography（CXR）performed and interpreted LUS examinations for PTX in participants undergoing CXR for PTX follow-up.治疗临床医生解释CXR中PTX的存在，以做出治疗决策。肺部超声随后由超声专家审查，CXR由放射科医生审查。我们将专家LUS解释定义为参考标准。计算住院医师进行的LUS检查诊断PTX的灵敏度和特异性。我们使用Cohen κ系数评估了经过培训的住院医师与专家LUS以及临床医师与放射学CXR之间的一致性。我们比较了LUS和CXR.ResultsOver 8个月期间，51名参与者的结果之间的时间。与专家LUS解释相比，居民LUS的灵敏度和特异性（95%置信区间）分别为100%（85%-100%）和96%（82%-100%），而临床医生解释的CXR的灵敏度和特异性分别为48%（27%-69%）和100%（88%-100%）。住院医师和专家LUS之间的一致性非常好（κ = 0.96），而临床医生和放射科医生CXR之间的一致性仅为中等（κ = 0.60）。CXR获得结果的时间显著长于LUS（平均1335分钟与396分钟;P= .0001）。结论在这项卢旺达研究中，与临床医生解释的CXR相比，住院医师进行的LUS检查是一种更快的成像方式，具有上级灵敏度。肺部超声是PTX随访的一种有价值的成像工具，特别是在资源有限的情况下。
ObjectivesThe aim of this study was to evaluate the accuracy and timeliness of resident‐performed point‐of‐care lung ultrasound (LUS) examinations for the follow‐up of pneumothorax (PTX) after tube thoracostomy.MethodsAfter brief training, Rwandan surgical residents blinded to chest radiography (CXR) performed and interpreted LUS examinations for PTX in participants undergoing CXR for PTX follow‐up. Treating clinicians interpreted CXR for the presence of PTX for therapeutic decisions. Lung ultrasound was later reviewed by ultrasound experts, and CXR was reviewed by a radiologist. We defined expert LUS interpretation as the reference standard. The sensitivity and specificity of resident‐performed LUS examinations for diagnosing PTX were calculated. We assessed agreement between trained resident versus expert LUS and clinician versus radiology CXR using the Cohen κ coefficient. We compared the time to results between LUS and CXR.ResultsOver an 8‐month period, 51 participants were enrolled. Compared to expert LUS interpretation, the sensitivity and specificity (95% confidence intervals) of resident LUS were 100% (85%–100%) and 96% (82%–100%), respectively, whereas the sensitivity and specificity of clinician‐interpreted CXR were 48% (27%–69%) and 100% (88%–100%). The agreement between resident and expert LUS was excellent (κ = 0.96), whereas the agreement between clinician and radiologist CXR was only moderate (κ = 0.60). The time to results was significantly longer for CXR than LUS (mean, 1335 versus 396 minutes;P= .0001).ConclusionsA resident‐performed LUS examination was a quicker imaging modality with superior sensitivity compared to clinician‐interpreted CXR for PTX follow‐up after tube thoracostomy in this Rwandan study. Lung ultrasound can be a valuable imaging tool for PTX follow‐up, especially in resource‐limited settings.