埃塞俄比亚急诊和重症医学住院医师对聚焦心脏超声解读的准确性:多中心横断面研究

IF 1.4 4区 医学 Q3 EMERGENCY MEDICINE
Nahom Mesfin Mekonen , Temesgen Beyene Abicho , Kalsidagn Girma Asfaw , Tigist Workneh Leulseged , Nebiat Adane Mera , Yegeta Wondafrash Habte , Fekadesilassie Henok Moges , Yidnekachew Asrat Birhan , Meron Tesfaye , Birhanu Tesfaye
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引用次数: 0

摘要

导言聚焦心脏超声(FoCUS)已成为急诊和重症监护医学的重要工具,可在床边快速评估心脏功能和结构。在埃塞俄比亚等资源有限的国家,这种快速诊断技术尤其具有前景,因为在这些国家,标准超声心动图的使用可能受到限制和延迟。然而,FoCUS 解读的准确性在很大程度上取决于操作者的技能和专业知识。为了为设计有效的干预措施提供信息,本研究旨在评估埃塞俄比亚两家大型转诊教学医院急诊医学科高级住院医师的 FoCUS 解读准确性及相关因素。方法 2023 年 10 月至 12 月,本研究对 Tikur Anbessa 专科医院和圣保罗医院千禧医学院的 80 名住院医师进行了横断面研究。为评估诊断准确性,从美国急诊医师学会网站和 PoCUS 图集中选取了 15 个预选的心脏超声视频(正常和病理病例),15 个读数中至少有 12 个读数回答正确即为准确解读。结果解释 FoCUS 结果的总体准确率为 47.5%(95% CI:38.8-60.0%),其中下腔静脉塌陷(91.3%)和静止(90.0%)的准确率最高,左心室区域壁运动异常(46.3%)的准确率最低。接受过培训的住院医师(AOR=4.14,95%CI:1.32-13.04,p = 0.015)、认为自己技术熟练的住院医师(AOR=4.81,95%CI=1.06-21.82,p = 0.042)以及对获取和判读有信心的住院医师(AOR=3.16,95%CI=1.01-9.82,p = 0.047)的准确率明显更高。模拟培训计划、持续教育和导师指导对提高这些关键技能至关重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Accuracy of focused cardiac ultrasound interpretation among emergency and critical care medicine residents in Ethiopia: A multi-center cross-sectional study

Introduction

Focused cardiac ultrasound (FoCUS) has emerged as a valuable tool in emergency and critical care medicine, allowing for rapid assessment of cardiac function and structure at the bedside. This rapid diagnostic technique holds particular promise in resource-limited settings like Ethiopia, where access to standard echocardiography may be limited and delayed. However, the accuracy of FoCUS interpretation is highly dependent on the operator's skills and expertise. To inform the design of effective interventions, the study aimed to assess the accuracy of FoCUS interpretation and associated factors among senior Emergency Medicine residents at two large referral teaching hospitals in Ethiopia.

Methods

A cross-sectional study was conducted from October to December 2023 among 80 residents at Tikur Anbessa Specialized Hospital and St. Paul's Hospital Millennium Medical College. To assess diagnostic accuracy, 15 pre-selected cardiac ultrasound videos (normal and pathological cases) were selected from American College of Emergency Physicians website and the PoCUS Atlas, and accurate interpretation was defined as correctly answering at least 12 out of 15 readings. A binary logistic regression model was fitted to identify significant factors at the 5% level of significance, where significant results were interpreted using adjusted odds ratio (AOR) with 95% confidence interval (CI).

Result

The overall accuracy in interpreting FoCUS findings was 47.5% (95% CI: 38.8–60.0%), with highest for collapsing Inferior Vena Cava (91.3%) and standstill (90.0%), and lowest for Regional Wall Motion Abnormality of Left Ventricle (46.3%). Residents who received training (AOR=4.14, 95%CI:1.32–13.04, p = 0.015), perceived themselves as skilled (AOR=4.81, 95%CI=1.06–21.82, p = 0.042), and felt confident in acquiring and interpretation (AOR=3.16, 95%CI=1.01–9.82, p = 0.047) demonstrated significantly higher accuracy.

Conclusion

The study identified a low overall accuracy in FoCUS interpretation, with accuracy improving with training and better perceived skill and confidence. Training programs with simulation, continuous education, and mentorship are crucial to enhance these critical skills.

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