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Clinical Trial
. 2012 Oct;44(10):576-83.
doi: 10.1016/j.aprim.2011.07.016. Epub 2011 Oct 22.

[Abdominal ultrasound: a diagnostic tool within the reach of general practitioners]

[Article in Spanish]
Marià Esquerrà  1 , Pere Roura Poch, Teresa Masat Ticó, Vicenç Canal, Joaquim Maideu Mir, Rafael Cruxent
Affiliations
Clinical Trial

[Abdominal ultrasound: a diagnostic tool within the reach of general practitioners]

[Article in Spanish]
Marià Esquerrà et al. Aten Primaria. 2012 Oct.

Abstract
in English, Spanish

Aim: To assess the impact of training two general practitioners (GPs), on performing low complexity ultrasound examinations of the abdomen with diagnostic competence.

Study design: A non-randomised, prospective, double blind evaluation study of the acquired competence. Ultrasound examinations were performed successively and independently by the GP and the radiologist, and registered on two sheets of an identical case report form.

Setting: Departments of Vic General Hospital and Vic Health Care Centre of the Catalan Health Institute.

Subjects: A total of 120 patients who needed a low complexity abdominal ultrasound from a total amount of 868 ultrasound examinations scheduled.

Main measurements: The kappa index of the primary diagnosis (ultrasound diagnostic conclusion), as well as of the ultrasound findings for each abdominal organ was calculated. A good level of training was considered if a minimum kappa index of 0.80 was attained between general practitioner and radiologist.

Results: After six month running, an "ad interim" analysis showed a kappa index for the primary ultrasound diagnosis of 0.85. At the end of the study, an overall kappa index of 0.89 (95% CI: 0.82-0.98) was achieved. The agreement by organs was also high (pancreas and spleen excluded), as well as sensitivity (>75%) and specificity (>90%).

Conclusions: The results of the study demonstrate the feasibility of the performance, by trained GPs, of ultrasound examinations of low complexity of the abdomen with diagnostic competence.

Objetivo: Evaluar el impacto de la formación, en términos de competencia diagnóstica, de 2 médicos de atención primaria formados para realizar ecografías abdominales de baja complejidad.

Diseño: Estudio no aleatorio prospectivo a doble ciego de evaluación de las competencias adquiridas. La exploración ecográfica se realizó sucesiva e independientemente por el médico de atención primaria y por el radiólogo y los resultados se registraron en formularios distintos de un mismo cuestionario de recogida de datos.

Emplazamiento: Departamentos de radiología del Hospital General de Vic y del ambulatorio de especialidades de Vic del Instituto Catalán de la Salud.

Participantes: Participaron 120 pacientes que requerían una ecografía abdominal de baja complejidad de un total de 868 ecografías programadas.

Mediciones principales: Se calculó el índice kappa del diagnóstico principal (conclusión diagnóstica de la prueba) y el de los hallazgos ecográficos en cada órgano abdominal. Se consideró un buen nivel de formación si se alcanzaba un índice kappa mínimo de 0,80 entre el médico de atención primaria y el radiólogo.

Resultados: En un análisis ad interim a los 6 meses se obtuvo un índice kappa de 0,85 para el diagnóstico ecográfico principal; al finalizar el estudio fue de 0,89 (IC 0,95: 0,82-0,98). La concordancia por órganos fue alta (excepto para páncreas y bazo) y se alcanzó una sensibilidad superior al 75% y una especificidad superior al 90%.

Conclusiones: Los resultados del estudio demuestran cautelosamente que los médicos de atención primaria pueden realizar ecografías abdominales de baja complejidad con competencia diagnóstica.

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Figures

None
Esquema general del estudio. Diagrama de las principales acciones del estudio.
See this image and copyright information in PMC

References

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