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The diagnostic accuracy of a point-of-care ultrasound protocol for shock etiology: A systematic review and meta-analysis

  • Sean P. Stickles (a1), Christopher R. Carpenter (a1), Robert Gekle (a2) (a3), Chadd K. Kraus (a4), Caryn Scoville (a5), Daniel Theodoro (a1), Vu Huy Tran (a6), George Ubiñas (a7) and Christopher Raio (a2)...
Abstract
CLINICIAN'S CAPSULE

What is known about the topic?

The rapid ultrasound for shock and hypotension (RUSH) exam has been suggested to help diagnose the etiology of undifferentiated shock.

What did this study ask?

What does the literature say regarding the diagnostic accuracy of the RUSH exam for shock etiology by subtype?

What did this study find?

The RUSH exam is better able to “rule in” than “rule out” most shock subtypes.

Why does this study matter to clinicians?

Diagnostic accuracy for shock evaluation can be improved with use of an ultrasound protocol, but additional clinical information should still be used.

Objectif

L’étude visait à réaliser une revue systématique et une méta-analyse de l'exactitude diagnostique de l’échographie au point de service dans le diagnostic des états de choc non différenciés au service des urgences.

Méthode

Une recherche documentaire a été entreprise dans les bases de données Ovid, MEDLINE, Scopus et le registre Cochrane Central Register of Controlled Trials ainsi que dans des résumés de congrès sur la recherche dans le but de relever des études pertinentes, de 1966 à juin 2018. La qualité des études a été évaluée à l'aide de QUADAS-2, et une méta-analyse, effectuée afin de réunir des données sur la performance de l'examen dans différentes catégories d’état de choc.

Résultats

Ont été relevées en tout 5097 études nouvelles, dont 58 ont fait l'objet d'un examen en version intégrale; sur ce dernier nombre, 4 ont été retenues aux fins de l'analyse. La qualité des études comportait, dans l'ensemble, un faible risque de bais, d'après l'instrument QUADAS-2. Les valeurs réunies des rapports de vraisemblance positifs variaient de 8,25 (IC à 95% : 3,29 à 20,69) pour les chocs d'origine hypovolémique à 40,54 (IC à 95% : 12,06 à 136,28) pour les chocs d'origine obstructive. Les valeurs réunies des rapports de vraisemblance négatifs variaient de 0,13 (IC à 95% : 0,04 à 0,48) pour les chocs d'origine obstructive à 0,32 (IC à 95% : 0,16 à 0,62) pour les chocs d'origine mixte.

Conclusion

L'EPS pratiquée d'urgence dans les cas de choc et d'hypotension donne de meilleurs résultats lorsqu'il s'agit d'inclure des causes d’état de choc que lorsqu'il s'agit d’écarter définitivement des causes particulières. D'après les rapports de vraisemblance négatifs répartis en sous-catégorie, l'examen permettrait d’écarter avec une grande exactitude les états de choc d'origine obstructive.

Copyright
Corresponding author
Correspondence to: Dr. Sean Stickles, Division of Emergency Medicine, Washington University School of Medicine, Campus Box 8072, 660 S. Euclid Ave., St. Louis, MO 63110; Email: spstickles@gmail.com
References
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