Point-of-care ultrasonography improves the diagnosis of splenomegaly in hospitalized patients.

IF 3.6 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING Critical Ultrasound Journal Pub Date : 2015-12-01 Epub Date: 2015-09-17 DOI:10.1186/s13089-015-0030-8
Andrew P J Olson, Bernard Trappey, Michael Wagner, Michael Newman, L James Nixon, Daniel Schnobrich
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引用次数: 22

Abstract

Background: It is important to detect splenomegaly as it can have important diagnostic implications. Previous studies, however, have shown that the traditional physical examination is limited in its ability to rule in or rule out splenomegaly.

Objective: To determine if performing point-of-care ultrasonography (POCUS) in addition to the traditional physical examination improves the sensitivity and specificity for diagnosing splenomegaly.

Methods: This was a prospective trial of diagnostic accuracy. Physical and sonographic examinations for splenomegaly were performed by students, residents and attending physicians enrolled in an ultrasound training course. Participants received less than 1 h training for ultrasound diagnosis of splenomegaly. The findings were compared to radiographic interpretation of gold standard studies.

Setting/patients: Hospitalized adult patients at an academic medical center without severe abdominal pain or recent surgery who had abdominal CT, MRI or ultrasound performed within previous 48 h.

Results: Thirty-nine subjects were enrolled. Five patients had splenomegaly (12.5 %). The physical examination for splenomegaly had a sensitivity of 40 % (95 % CI 12-77 %) and specificity of 88 % (95 % CI 74-95 %) while physical examination plus POCUS had a sensitivity of 100 % (95 % CI 57-100 %) and specificity of 74 % (95 % CI 57-85 %). Physical examination alone for splenomegaly had an LR+ of 3.4 (95 % CI 0.83-14) and LR- of 0.68 (95 % CI 0.33-1.41); for physical exam plus POCUS the LR+ was 3.8 (2.16-6.62) and LR- was 0.

Conclusions: Point-of-care ultrasonography significantly improves examiners' sensitivity in diagnosing splenomegaly.

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即时超声检查提高了住院患者脾肿大的诊断。
背景:脾肿大的检测具有重要的诊断意义。然而,先前的研究表明,传统的体检在排除脾肿大的能力上是有限的。目的:探讨在传统体检的基础上加行点旁超声检查(POCUS)是否能提高脾肿大诊断的敏感性和特异性。方法:这是一项诊断准确性的前瞻性试验。脾肿大的物理和超声检查由参加超声培训课程的学生、住院医生和主治医生进行。参与者接受不到1小时的超声诊断脾肿大的培训。研究结果与金标准研究的放射学解释进行了比较。环境/患者:在学术医疗中心住院的成人患者,无严重腹痛或近期手术,并在过去48小时内进行了腹部CT、MRI或超声检查。脾肿大5例(12.5%)。体格检查对脾肿大的敏感性为40% (95% CI 12 ~ 77%),特异性为88% (95% CI 74 ~ 95%),体格检查加POCUS的敏感性为100% (95% CI 57 ~ 100%),特异性为74% (95% CI 57 ~ 85%)。单纯体格检查脾肿大的LR+为3.4 (95% CI 0.83-14), LR-为0.68 (95% CI 0.33-1.41);体检+ POCUS组LR+为3.8 (2.16 ~ 6.62),LR-为0。结论:即时超声检查可显著提高脾肿大诊断的敏感性。
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来源期刊
Critical Ultrasound Journal
Critical Ultrasound Journal RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING-
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