Prisca Mary Kizito , Kenneth Daniel Bagonza , Justine Athieno Odakha , Linda Grace Nalugya , Pius Opejo , Anthony Muyingo , Harry Chen , Derek Harborne
{"title":"乌干达一家教学医院急诊科的点超声与胸部x线对缺氧患者的诊断效果比较","authors":"Prisca Mary Kizito , Kenneth Daniel Bagonza , Justine Athieno Odakha , Linda Grace Nalugya , Pius Opejo , Anthony Muyingo , Harry Chen , Derek Harborne","doi":"10.1016/j.afjem.2023.02.004","DOIUrl":null,"url":null,"abstract":"<div><h3>Background</h3><p>Hypoxia is a common presentation in the Emergency Department (ED) worldwide. It affects 9-12% of hospitalized adults in Sub-Saharan Africa. Timely diagnosis of the multiple causes such as pneumonia, heart failure among others is challenging. Chest X-Ray (CXR), one of the most utilized imaging modalities has many limitations, and the gold standard (Computed Tomography scan) is inaccessible. Point of care ultrasound (PoCUS) is more available and increasingly being used, however little is known of its performance in resource limited EDs. The study aimed to assess the diagnostic performance of PoCUS compared with CXR in identifying the causes of hypoxia in the medical ED.</p></div><div><h3>Methods</h3><p>49 adults presenting with hypoxia (SP02 ≤ 88%) in the medical ED were evaluated. Ultrasound of the lungs and heart (PoCUS) was done, then CXR obtained. Lung ultrasound (LUS) was compared with CXR (first reference standard). Chest X-Ray and PoCUS were each compared to the physician diagnosis (second reference standard) to determine agreement using an acceptable disagreement cut-off of 15%.</p></div><div><h3>Results</h3><p>31% more abnormalities were identified by LUS than CXR. Lung ultrasound findings agreed with CXR in 86% of the participants with moderate reliability (ĸ=0.75). There was no significant difference between the actual findings of the two tests (X<sup>2</sup>= 2, p 0.1). Using the second reference, 82% of the CXRs were similar with weak reliability (ĸ=0.5) compared to 98% of PoCUS findings with strong reliability (ĸ=0.9). Compared to PoCUS, CXRs significantly differed from the physician diagnosis (X<sup>2</sup>= 0.85, p 0.38 vs X<sup>2</sup>= 8.5, p 0.004 respectively).</p></div><div><h3>Conclusion</h3><p>Overall, PoCUS was not inferior to CXR when compared to final physician diagnosis in identifying causes of hypoxia, and LUS and CXR had comparable performance. Significantly more abnormalities were identified on PoCUS and it demonstrated better agreement and strong reliability with the physician diagnosis than CXR. We recommend PoCUS use in patients with hypoxia attending resource limited in- and pre-hospital settings.</p></div>","PeriodicalId":48515,"journal":{"name":"African Journal of Emergency Medicine","volume":"13 2","pages":"Pages 61-67"},"PeriodicalIF":1.4000,"publicationDate":"2023-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10019986/pdf/","citationCount":"2","resultStr":"{\"title\":\"Diagnostic Performance of Point of Care Ultrasound Compared to Chest X-Ray in Patients with Hypoxia at a Teaching Hospital Emergency Department in Uganda\",\"authors\":\"Prisca Mary Kizito , Kenneth Daniel Bagonza , Justine Athieno Odakha , Linda Grace Nalugya , Pius Opejo , Anthony Muyingo , Harry Chen , Derek Harborne\",\"doi\":\"10.1016/j.afjem.2023.02.004\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div><h3>Background</h3><p>Hypoxia is a common presentation in the Emergency Department (ED) worldwide. It affects 9-12% of hospitalized adults in Sub-Saharan Africa. Timely diagnosis of the multiple causes such as pneumonia, heart failure among others is challenging. Chest X-Ray (CXR), one of the most utilized imaging modalities has many limitations, and the gold standard (Computed Tomography scan) is inaccessible. Point of care ultrasound (PoCUS) is more available and increasingly being used, however little is known of its performance in resource limited EDs. The study aimed to assess the diagnostic performance of PoCUS compared with CXR in identifying the causes of hypoxia in the medical ED.</p></div><div><h3>Methods</h3><p>49 adults presenting with hypoxia (SP02 ≤ 88%) in the medical ED were evaluated. Ultrasound of the lungs and heart (PoCUS) was done, then CXR obtained. Lung ultrasound (LUS) was compared with CXR (first reference standard). Chest X-Ray and PoCUS were each compared to the physician diagnosis (second reference standard) to determine agreement using an acceptable disagreement cut-off of 15%.</p></div><div><h3>Results</h3><p>31% more abnormalities were identified by LUS than CXR. Lung ultrasound findings agreed with CXR in 86% of the participants with moderate reliability (ĸ=0.75). There was no significant difference between the actual findings of the two tests (X<sup>2</sup>= 2, p 0.1). Using the second reference, 82% of the CXRs were similar with weak reliability (ĸ=0.5) compared to 98% of PoCUS findings with strong reliability (ĸ=0.9). Compared to PoCUS, CXRs significantly differed from the physician diagnosis (X<sup>2</sup>= 0.85, p 0.38 vs X<sup>2</sup>= 8.5, p 0.004 respectively).</p></div><div><h3>Conclusion</h3><p>Overall, PoCUS was not inferior to CXR when compared to final physician diagnosis in identifying causes of hypoxia, and LUS and CXR had comparable performance. Significantly more abnormalities were identified on PoCUS and it demonstrated better agreement and strong reliability with the physician diagnosis than CXR. 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引用次数: 2
摘要
背景缺氧是世界各地急诊科常见的表现。它影响了撒哈拉以南非洲9-12%的住院成年人。及时诊断肺炎、心力衰竭等多种原因是一项挑战。胸部X射线(CXR)是最常用的成像方式之一,有许多局限性,金标准(计算机断层扫描)是无法实现的。护理点超声(PoCUS)在资源有限的ED中的应用越来越多,但人们对其性能知之甚少。本研究旨在评估PoCUS与CXR在确定医学ED缺氧原因方面的诊断性能。方法对49名在医学ED中出现缺氧(SP02≤88%)的成人进行评估。对肺和心脏进行超声检查(PoCUS),然后获得CXR。将肺部超声(LUS)与CXR(第一参考标准)进行比较。将胸部X光和PoCUS分别与医生诊断(第二参考标准)进行比较,以确定一致性,可接受的不一致截止值为15%。结果LUS比CXR多31%的异常。86%的参与者的肺部超声检查结果与CXR一致,具有中等可靠性(ĸ=0.75)。两项测试的实际结果之间没有显著差异(X2=2,p 0.1)。使用第二个参考,82%的CXR相似,具有弱可靠性(\312;=0.5),而PoCUS检查结果的98%具有强可靠性(\3.12;=0.9)。与PoCUS相比,CXR与医生诊断有显著差异(X2=0.85,p 0.38 vs X2=8.5,p 0.004)。结论总体而言,与最终医生诊断相比,PoCUS在识别缺氧原因方面并不劣于CXR,LUS和CXR具有可比的性能。PoCUS上发现的异常明显更多,与CXR相比,它与医生诊断的一致性更好,可靠性更强。我们建议在资源有限的院内和院前环境中使用PoCUS治疗缺氧患者。
Diagnostic Performance of Point of Care Ultrasound Compared to Chest X-Ray in Patients with Hypoxia at a Teaching Hospital Emergency Department in Uganda
Background
Hypoxia is a common presentation in the Emergency Department (ED) worldwide. It affects 9-12% of hospitalized adults in Sub-Saharan Africa. Timely diagnosis of the multiple causes such as pneumonia, heart failure among others is challenging. Chest X-Ray (CXR), one of the most utilized imaging modalities has many limitations, and the gold standard (Computed Tomography scan) is inaccessible. Point of care ultrasound (PoCUS) is more available and increasingly being used, however little is known of its performance in resource limited EDs. The study aimed to assess the diagnostic performance of PoCUS compared with CXR in identifying the causes of hypoxia in the medical ED.
Methods
49 adults presenting with hypoxia (SP02 ≤ 88%) in the medical ED were evaluated. Ultrasound of the lungs and heart (PoCUS) was done, then CXR obtained. Lung ultrasound (LUS) was compared with CXR (first reference standard). Chest X-Ray and PoCUS were each compared to the physician diagnosis (second reference standard) to determine agreement using an acceptable disagreement cut-off of 15%.
Results
31% more abnormalities were identified by LUS than CXR. Lung ultrasound findings agreed with CXR in 86% of the participants with moderate reliability (ĸ=0.75). There was no significant difference between the actual findings of the two tests (X2= 2, p 0.1). Using the second reference, 82% of the CXRs were similar with weak reliability (ĸ=0.5) compared to 98% of PoCUS findings with strong reliability (ĸ=0.9). Compared to PoCUS, CXRs significantly differed from the physician diagnosis (X2= 0.85, p 0.38 vs X2= 8.5, p 0.004 respectively).
Conclusion
Overall, PoCUS was not inferior to CXR when compared to final physician diagnosis in identifying causes of hypoxia, and LUS and CXR had comparable performance. Significantly more abnormalities were identified on PoCUS and it demonstrated better agreement and strong reliability with the physician diagnosis than CXR. We recommend PoCUS use in patients with hypoxia attending resource limited in- and pre-hospital settings.