Rosemary Thomas-Mohtat, Craig Sable, Kristen Breslin, Jacqueline G Weinberg, Aparna Prasad, Lauren Zinns, Joanna S Cohen
{"title":"新手儿科急诊医学同行超声医师对聚焦心脏超声的解释错误。","authors":"Rosemary Thomas-Mohtat, Craig Sable, Kristen Breslin, Jacqueline G Weinberg, Aparna Prasad, Lauren Zinns, Joanna S Cohen","doi":"10.1186/s13089-018-0113-4","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition.</p><p><strong>Methods: </strong>PEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard. Subsequently, eight different PEM fellows remotely interpreted a subset of the PEM-acquired and cardiology-acquired echocardiograms.</p><p><strong>Results: </strong>Eight PEM fellows performed 54 FOCUS exams, of which two had pericardial effusion and four had diminished function. PEM fellow FOCUS had a sensitivity of 50.0% (95% CI 9.19-90.8) and specificity of 100.0% (95% CI 91.1-100.0) for detecting diminished function, and sensitivity of 50.0% (95% CI 2.67-97.33) and specificity of 98.1% (95% CI 88.42-99.9) for detecting pericardial effusions. When PEM fellows remotely interpreted 15 echocardiograms, the sensitivity was 81.3% (95% CI 70.7-88.8) and specificity 75% (95% CI 67.0-81.0) for detecting diminished function, and sensitivity of 76.3% (95% CI 65.0-85.0) and specificity 94.4% (95% CI 89.0-97.0) for detecting pericardial effusion. There were no differences in sensitivity and specificity of PEM fellows' interpretation of FOCUS studies compared to their interpretation of cardiology echocardiograms. Interrater reliability for interpretation of remote images (kappa) was 0.66 (95% CI 0.59-0.73) for effusion and 0.31 (95% CI 0.24-0.38) for function among the fellows.</p><p><strong>Conclusion: </strong>Novice PEM fellow sonologists (a physician who performs and interprets ultrasound) in the majority of instances were able to acquire and remotely interpret FOCUS images with limited training. However, they made real-time interpretation errors and likely need further training to incorporate real-time image acquisition and interpretation into their practice.</p>","PeriodicalId":46598,"journal":{"name":"Critical Ultrasound Journal","volume":null,"pages":null},"PeriodicalIF":3.6000,"publicationDate":"2018-12-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1186/s13089-018-0113-4","citationCount":"5","resultStr":"{\"title\":\"Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists.\",\"authors\":\"Rosemary Thomas-Mohtat, Craig Sable, Kristen Breslin, Jacqueline G Weinberg, Aparna Prasad, Lauren Zinns, Joanna S Cohen\",\"doi\":\"10.1186/s13089-018-0113-4\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition.</p><p><strong>Methods: </strong>PEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard. Subsequently, eight different PEM fellows remotely interpreted a subset of the PEM-acquired and cardiology-acquired echocardiograms.</p><p><strong>Results: </strong>Eight PEM fellows performed 54 FOCUS exams, of which two had pericardial effusion and four had diminished function. PEM fellow FOCUS had a sensitivity of 50.0% (95% CI 9.19-90.8) and specificity of 100.0% (95% CI 91.1-100.0) for detecting diminished function, and sensitivity of 50.0% (95% CI 2.67-97.33) and specificity of 98.1% (95% CI 88.42-99.9) for detecting pericardial effusions. When PEM fellows remotely interpreted 15 echocardiograms, the sensitivity was 81.3% (95% CI 70.7-88.8) and specificity 75% (95% CI 67.0-81.0) for detecting diminished function, and sensitivity of 76.3% (95% CI 65.0-85.0) and specificity 94.4% (95% CI 89.0-97.0) for detecting pericardial effusion. There were no differences in sensitivity and specificity of PEM fellows' interpretation of FOCUS studies compared to their interpretation of cardiology echocardiograms. Interrater reliability for interpretation of remote images (kappa) was 0.66 (95% CI 0.59-0.73) for effusion and 0.31 (95% CI 0.24-0.38) for function among the fellows.</p><p><strong>Conclusion: </strong>Novice PEM fellow sonologists (a physician who performs and interprets ultrasound) in the majority of instances were able to acquire and remotely interpret FOCUS images with limited training. 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引用次数: 5
摘要
背景:聚焦心脏超声(FOCUS)是儿科急诊医学(PEM)研究员的核心能力。本研究的目的是(1)评估pem -fellow进行的FOCUS检测心包积液和心功能减退的测试特征;(2)评估独立于图像采集的图像解释。方法:PEM研究员对同时接受心脏服务超声心动图(参考标准)的患者进行并解释FOCUS。随后,8名不同的PEM研究员远程解释了PEM获得性和心脏病学获得性超声心动图的一部分。结果:8名PEM患者进行了54次FOCUS检查,其中2人有心包积液,4人功能减退。PEM fellow FOCUS检测功能减退的灵敏度为50.0% (95% CI 9.19-90.8),特异性为100.0% (95% CI 91.1-100.0),检测心包积水的灵敏度为50.0% (95% CI 2.67-97.33),特异性为98.1% (95% CI 88.42-99.9)。当PEM研究员远程解释15张超声心动图时,检测功能减退的灵敏度为81.3% (95% CI 70.7-88.8),特异性为75% (95% CI 67.0-81.0),检测心包积液的灵敏度为76.3% (95% CI 65.0-85.0),特异性为94.4% (95% CI 89.0-97.0)。PEM研究员对FOCUS研究的敏感性和特异性与他们对心脏科超声心动图的解释没有差异。对于积液,远程图像解释的信度(kappa)为0.66 (95% CI 0.59-0.73),对于功能,其信度为0.31 (95% CI 0.24-0.38)。结论:在大多数情况下,初级PEM超声医师(执行和解释超声的医生)在有限的训练下能够获取和远程解释FOCUS图像。然而,他们犯了实时解释错误,可能需要进一步的培训,以将实时图像采集和解释纳入他们的实践。
Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists.
Background: Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition.
Methods: PEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard. Subsequently, eight different PEM fellows remotely interpreted a subset of the PEM-acquired and cardiology-acquired echocardiograms.
Results: Eight PEM fellows performed 54 FOCUS exams, of which two had pericardial effusion and four had diminished function. PEM fellow FOCUS had a sensitivity of 50.0% (95% CI 9.19-90.8) and specificity of 100.0% (95% CI 91.1-100.0) for detecting diminished function, and sensitivity of 50.0% (95% CI 2.67-97.33) and specificity of 98.1% (95% CI 88.42-99.9) for detecting pericardial effusions. When PEM fellows remotely interpreted 15 echocardiograms, the sensitivity was 81.3% (95% CI 70.7-88.8) and specificity 75% (95% CI 67.0-81.0) for detecting diminished function, and sensitivity of 76.3% (95% CI 65.0-85.0) and specificity 94.4% (95% CI 89.0-97.0) for detecting pericardial effusion. There were no differences in sensitivity and specificity of PEM fellows' interpretation of FOCUS studies compared to their interpretation of cardiology echocardiograms. Interrater reliability for interpretation of remote images (kappa) was 0.66 (95% CI 0.59-0.73) for effusion and 0.31 (95% CI 0.24-0.38) for function among the fellows.
Conclusion: Novice PEM fellow sonologists (a physician who performs and interprets ultrasound) in the majority of instances were able to acquire and remotely interpret FOCUS images with limited training. However, they made real-time interpretation errors and likely need further training to incorporate real-time image acquisition and interpretation into their practice.