背景:化脓性髋关节炎的评估通常包括利用髋关节超声检查来确定髋关节积液的存在,以及指导关节穿刺术。先前已证明由急诊医师执行时的定点护理(POC)髋关节超声检查是准确的。化脓性关节炎(SA)的诊断和后续干预时间对于良好的预后至关重要。
方法:回顾性单中心研究对所有急诊(ED)患者进行了POC或放射学髋关节超声检查或关节穿刺术,作为他们在3年内对SA进行ED评估的一部分。我们调查了在疑似化脓性髋关节关节炎的情况下,放射学和急诊医师进行的研究之间获得髋关节超声检查结果的时间和进行关节穿刺术的时间差异。
结果:74例患者符合纳入标准。髋关节超声检查完成的中位时间为68(四分位距[IQR],急诊医师执行超声组的38.8-132)分钟与208.5(IQR,放射学组163.8-301.3)分钟(P<0.001)。共有17例患者进行了髋关节穿刺术。急诊医师进行关节穿刺术组的关节穿刺术时间为211(IQR141.3-321.5)分钟,放射学关节穿刺术组为602(IQR500-692)分钟(P<0.001)。
结论:急诊医师使用POC髋关节超声时,超声结果和关节穿刺术的时间在统计学上较短。鉴于SA的不利结果与治疗延迟有关,需要进一步研究以确定急诊医师进行的髋关节超声和关节穿刺术是否可以改善以患者为中心的临床终点.
BACKGROUND: The evaluation of septic hip arthritis often incorporates the utilization of hip ultrasonography to determine the presence of a hip joint effusion, as well as to guide arthrocentesis. Point-of-care (POC) hip ultrasound has previously been demonstrated to be accurate when performed by the emergency physician. Time to diagnosis and subsequent intervention in septic arthritis (SA) is critical to favorable outcomes.
METHODS: Retrospective single-center study of all emergency department (ED) patients who had a POC or radiology hip ultrasound or arthrocentesis as part of their ED evaluation for SA in a 3-year period. We investigated the difference in time to obtain hip ultrasonography results and the time to arthrocentesis between radiology and emergency physician-performed studies in cases of suspected septic hip arthritis.
RESULTS: Seventy-four patients met inclusion criteria. The median time to hip ultrasound completion was 68 (interquartile range [IQR], 38.8-132) minutes in the emergency physician-performed ultrasound group versus 208.5 (IQR, 163.8-301.3) minutes for the radiology group (P < 0.001). A total of 17 patients had a hip arthrocentesis performed. Time to arthrocentesis was 211 (IQR 141.3-321.5) minutes in the emergency physician-performed arthrocentesis group and 602 (IQR 500-692) minutes in the radiology arthrocentesis (P < 0.001).
CONCLUSIONS: There was a statistically shorter time to ultrasound result and arthrocentesis when POC hip ultrasound was utilized by the emergency physician. Given that unfavorable outcomes in SA are associated with delay in treatment, further study is warranted to determine if emergency physician-performed hip ultrasound and arthrocentesis could lead to improved patient-centered clinical end points.