Sensitivity, specificity and diagnostic accuracy of novices integrating lung ultrasound into the care of breathless older patients.
Sensitivity, specificity and diagnostic accuracy of novices integrating lung ultrasound into the care of breathless older patients.
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DOI：
10.1002/j.2205-0140.2015.tb00221.x
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发表时间：
2015-11-01
影响因子：
--
通讯作者：
Brierley, Stephen
中科院分区：
文献类型：
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作者：
Baker, Kylie;Soong, Luke;Brierley, Stephen
背景：肺部超声经常用于识别肺水肿，使用“B线”伪影。2011年的一项小型研究表明，当在不参考其他患者信息的情况下进行测试时，新手超声医师的潜在诊断准确率为85%。目的：我们的目的是测试的总体诊断准确性的新手临床超声医师纳入2011年的协议，以例行评估的病人。方法：一个前瞻性的方便样本的呼吸困难的老年患者提出的艾德接受了8视图肺部扫描早期管理。最初的艾德诊断，利用所有信息，包括超声结果，与医疗专家的意见进行比较，审计患者出院后的记录。结果：5名新手的队列扫描了63例病例，其中11例被排除在外。使用超声的新手区分肺水肿和其他原因的呼吸困难的敏感性为71%（95%CI 44 - 87），特异性为91%（76 - 98），诊断准确性为85%（72 - 92），阳性LR为8.2（2.7 - 25），阴性LR为0.32（0.15 - 0.68）。讨论内容：急诊科临床医生将新手肺部超声纳入呼吸困难调查的诊断准确性与与患者护理同时进行的扫描的诊断准确性一致，并且可能比当前对传统艾德诊断策略的估计有所改进。临床医生不应该担心他们的学习曲线会对病人不利。
Background: Lung ultrasound is frequently used to identify pulmonary oedema, using the 'B line' artefact. A small study in 2011 suggested that novice sonologists had a potential diagnostic accuracy of 85%, when performing the test without reference to other patient information. Aim: We aimed to test the overall diagnostic accuracy of novice clinician sonologists incorporating the 2011 protocol into routine assessment of the patient. Method: A prospective convenience sample of breathless older patients presenting to ED received an 8-view lung scan early in management. Initial ED diagnoses, utilising all information including ultrasound result, were compared against the opinion of a medical expert auditing the patient records after discharge from hospital. Results: The cohort of five novices scanned 63 cases, from which eleven were excluded. Novices using ultrasound differentiated between pulmonary oedema and other causes of breathlessness with a sensitivity of 71% (95%CI 44 to 87), Specificity of 91% (76 to 98), a diagnostic accuracy of 85% (72 to 92), a positive LR of 8.2 (2.7 to 25) and a negative LR of 0.32 (0.15 to 0.68). Discussion: The diagnostic accuracy of emergency department clinicians incorporating novice lung ultrasound into the investigation of breathlessness is consistent with the diagnostic accuracy of scanning performed in parallel to patient care, and is likely to be an improvement on current estimates of conventional ED diagnostic strategies. Clinicians should not be afraid that their learning curve would disadvantage the patient.