初级保健医生对临床疑似社区获得性肺炎进行肺部超声检查:一项多中心前瞻性研究

F. J. Rodríguez-Contreras, Antonio Calvo-Cebrián, Juncal Díaz-Lázaro, M.L. Cruz-Arnes, Fernando León-Vázquez, María del Carmen Lobón-Agúndez, Francisco Javier Palau-Cuevas, Paloma Henares-García, Fernando Gavilán-Martínez, S. Fernández-Plaza, Carmelo Prieto-Zancudo
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引用次数: 1

摘要

目的:与胸片相比,我们调查了在初级保健中进行的肺部超声(US)对诊断社区获得性肺炎(CAP)是否有用和可行,因为大多数先前的研究都是在医院环境中进行的。方法:我们在12个初级保健中心进行了一项肺部US的前瞻性观察队列研究。5岁及以上有CAP症状的患者在同一天接受肺超声检查(由21名家庭医生和7名初级保健儿科医生)和胸片检查。考虑到后者是初级保健中对疑似CAP最常见的影像学检查,我们将肺超声检查结果与放射科医生的胸片报告作为参考标准进行了比较。这些医生之前有不同的美国经验,但都接受了5小时的美国肺部培训计划。结果纳入82例患者。与胸片相比,肺US阳性表现(实变>1 cm或局灶性/不对称b线模式)的敏感性为87.8%,特异性为58.5%,阳性似然比为2.12,阴性似然比为0.21。无论医生之前在美国接受的培训或经历如何,研究结果都是相似的。我们提出了一种实用的算法,即实变测量大于1厘米或肺超声检查结果正常的患者可以跳过胸片检查,而没有实变的b线型患者(鉴于其低特异性)则需要胸片检查以确保适当的管理。肺超声一般在10分钟或更短时间内完成。结论:初级保健中的即时肺部超声检查可用于调查疑似CAP(在大多数情况下避免胸部x线摄影),并且在日常实践中可能是可行的,因为短期培训计划似乎足够,并且需要很少的时间进行扫描。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
Lung Ultrasound Performed by Primary Care Physicians for Clinically Suspected Community-Acquired Pneumonia: A Multicenter Prospective Study
PURPOSE We investigated whether lung ultrasound (US) performed in primary care is useful and feasible for diagnosing community-acquired pneumonia (CAP) compared with chest radiography, as most previous research has been conducted in hospital settings. METHODS We undertook a prospective observational cohort study of lung US performed in 12 primary care centers. Patients aged 5 years and older with symptoms suggesting CAP were examined with lung US (by 21 family physicians and 7 primary care pediatricians) and chest radiograph on the same day. We compared lung US findings with the radiologist’s chest radiograph report as the reference standard, given that the latter is the most common imaging test performed for suspected CAP in primary care. The physicians had varied previous US experience, but all received a 5-hour lung US training program. RESULTS The study included 82 patients. Compared with chest radiography, positive lung US findings (consolidation measuring >1 cm or a focal/asymmetrical B-lines pattern) showed a sensitivity of 87.8%, a specificity of 58.5%, a positive likelihood-ratio of 2.12, and a negative likelihood-ratio of 0.21. Findings were similar regardless of the physicians’ previous US training or experience. We propose a practical algorithm whereby patients having consolidation measuring greater than 1 cm or normal findings on lung US could skip chest radiography, whereas patients with a B-lines pattern without consolidation (given its low specificity) would need chest radiography to ensure appropriate management. Lung US was generally performed in 10 minutes or less. CONCLUSION Point-of-care lung US in primary care could be useful for investigating suspected CAP (avoiding chest radiography in most cases) and is likely feasible in daily practice, as short training programs appear sufficient and little time is needed to perform the scan.
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