Ultrasonography by emergency physicians in patients with suspected ureteral colic

We performed a prospective study of patients with suspected ureteral colic to evaluate the test characteristics of bedside renal ultrasonography (US) performed by emergency physicians (EPs) for detecting hydronephrosis, and to evaluate how US can be used to predict the likelihood of nephrolithiasis. Thirteen EPs performed US, recorded the presence of hydronephrosis, and made an assessment of the likelihood of nephrolithiasis. All patients underwent i.v. pyelography (IVP) or unenhanced helical computed tomography (CT). There were 126 patients in the study: 84 underwent IVP; 42 underwent helical CT. Test characteristics of bedside US for detecting hydronephrosis were: sensitivity 72%, specificity 73%, positive predictive value (PPV) 85%, negative predictive value (NPV) 54%, accuracy 72%. The PPV and NPV for the ability of the EP to predict nephrolithiasis after performing US were 86% and 75%, respectively. We conclude that bedside US performed by EPs may be used to detect hydronephrosis and help predict the presence of nephrolithiasis.     

Ultrasonography by emergency physicians in patients with suspected cholecystitis

This article investigates the use of bedside abdominal ultrasonography (BAU) performed by emergency physicians (EPs) to screen patients for cholelithiasis and cholecystitis. In this prospective study EPs performed BAU on 116 patients. Agreement between BAU and formal abdominal ultrasound (FUS) performed in the radiology department for detecting cholelithiasis and cholecystitis was determined using Kappa statistics. Test characteristics of BAU for detecting cholelithiasis and acute cholecystitis were calculated. Agreement between BAU and FUS was 0.71 for cholelithiasis and 0.46 for acute cholecystitis. Test characteristics of BAU for cholelithiasis were sensitivity 92%, specificity 78%, positive predictive value (PPV) 86%, negative predictive value (NPV) 88%. Test characteristics of BAU for acute cholecystitis compared with clinical follow-up were sensitivity 91%, specificity 66%, PPV 70%, NPV 90%. BAU may be used to exclude cholelithiasis and is sensitive for cholecystitis. However, when EPs with limited experience identify cholecystitis a confirmatory test is warranted before cholecystectomy.     

Bedside Emergency Department Ultrasonography plus Radiography of the Kidneys, Ureters, and Bladder vs Intravenous Pyelography in the Evaluation of Suspected Ureteral Colic

Abstract. Objective : To determine the role of bedside renal ultrasonography (US) and plain radiography of the kidneys, ureters, and bladder (KUB) as the initial investigative modality for those patients presenting to the ED with unilateral flank pain and he-maturia. The hypothesis was that the renal US + KUB may obviate the need for emergent IV pyelography (IVP) in a majority of patients. Methods : Prospective study over an 8-month period of all consecutive adult patients between the ages of 18 and 65 years presenting with unilateral flank pain and he-maturia to the ED at LAC + USC Medical Center. Patients received KUB followed by a 500-mL bolus of normal saline. Bedside US was then performed by emergency physicians (EPs). Hydronephrosis of the kidney was graded as mild, moderate, or severe. All patients then underwent IVP. The results of the bedside US + KUB were then compared with those of IVP (the criterion standard). Results : Of a total of 139 eligible patients, 108 were enrolled. The combination of US and KUB correctly identified pathology consistent with nephroureterolithiasis with a sensitivity of 97.1% (95% CI = 93.1–100%) when compared with IVP. The KUB + US results were falsely positive in 16 patients, resulting in a specificity of 58.9% (95% CI = 43.5–74.3%). The positive predictive value of the combined modality was 80.7%, the negative predictive value was 92.0%, and the overall accuracy was 83.3%. Conclusion : The bedside US + KUB has a high sensitivity and can be performed rapidly at the bedside by the EP when compared with IVP. This combined modality is an effective screening tool in the initial evaluation of ureteral colic.     

The usefulness of ultrasound colour-Doppler twinkling artefact for detecting urolithiasis compared with low dose nonenhanced computerized tomography

This prospective study evaluates the usefulness of the twinkling artefact (TA) seen on colour-Doppler ultrasound (US) in diagnosing urolithiasis. US and standard computed tomography (CT) were performed blinded on 105 patients. B-mode US and colour-Doppler used separately and in combination showed 55% sensitivity and 99% specificity (positive predictive value [PPV] 67% and negative predictive value [NPV] 98%). Of CT verified stones, 61% were ≤3 mm. TAs were present in 74% of the B-mode stones (43% of all CT verified stones). Patients with CT verified stone disease had significantly more TAs in other foci than the stone(s) found on CT, suggestive of microlithiasis. In conclusion, colour-Doppler TA is a helpful supplement for detecting urolithiasis when CT is contraindicated. In addition, US can be valuable in monitoring stones left to pass without intervention if they have presented a TA. CT, US and US with colour-Doppler TA can be useful as complementary techniques for detecting stones.     

Real-time elastography in the diagnosis of prostate tumor

AimTo assess the diagnostic gain of transrectal real-time elastography (RTE) compared to transrectal B-mode ultrasonography (US) in the detection of tumors in patients suspected of having prostate cancer.Materials and methodsEighty-four patients suspected of having prostate cancer on the basis of clinical and biochemical evaluation underwent transrectal US, RTE and transperineal prostate biopsy.ResultsBiopsy was considered the gold standard. Analysis related to the total number of patients showed a B-mode US sensitivity of 56%, specificity 80%, positive predictive value (PPV) 70% and negative predictive value (NPV) 67%. Analysis related to the total number of biopsy cores showed sensitivity 33%, specificity 92%, PPV 69% and NPV 73%. In the patient-related analysis, RTE sensitivity was 51%, specificity 75%, PPV 64% and NPV 64%, while the core-related analysis showed sensitivity 36%, specificity 93%, PPV 72% and NPV 74%. Comparison of B-mode US and RTE diagnostic accuracy in the detection of tumors located in the peripheral zone of the prostate gland showed a significant difference. Analysis related to the total number of biopsy cores harvested in the peripheral zone of the prostate gland showed a B-mode US sensitivity of 48%, specificity 81%, PPV 75% and NPV 58%, whereas RTE achieved the following values: sensitivity 66%, specificity 78%, PPV 77%, and NPV 67%.ConclusionsRTE is a valid addition to B-mode US, and RTE reached a higher accuracy than B-mode US in the evaluation of the peripheral zone of the prostate gland and in the selection of appropriate biopsy sites.     

Ultrasonography to Evaluate Adults for Appendicitis: Decision Making Based on Meta-analysis and Probabilistic Reasoning

Objectives: To review ultrasonography (US) test performance and to develop recommendations for the use of US to aid in the evaluation of potential appendicitis.
Methods: A meta-analysis was conducted using all English-language articles published since 1986 (17 studies; 3,358 patients) to ascertain sensitivity and specificity of US for diagnosing appendicitis in adults and teenagers. Calculation of the predictive value of US was performed for three groups of patients: group I—usually operated on (prevalence of appendicitis = 80%); group II—usually observed in hospital (prevalence = 40%); and group III—usually released home (prevalence 2%).
Results: Overall sensitivity was 84.7% (95% CI: 81.0–87.8%), and specificity 92.1% (88.0–95.2). The accuracy and usefulness of US were related to the likelihood of appendicitis. In group I, a positive test was accurate [positive predictive value (PPV) = 97.6%], but a negative study could not rule out appendicitis [negative predictive value (NPV) = 59.5%]. The converse was true for group III patients (PPV = 19.5%, NPV = 99.7%). Test performance accuracy was balanced only for group II patients (PPV = 87.3%, NPV = 89.9%).
Conclusions: 1) US should not be used to exclude appendicitis for patients who have "classic" signs/symptoms, due to the underlying high false-negative rate. 2) US is most useful for patients who have an indeterminate probability of disease after the initial evaluation—if US is positive, the patient should have an operation; otherwise, he or she should be observed. 3) US is not recommended for screening patients who have a low probability of appendicitis, due to the low prevalence of disease and high false-positive rate in this group.     

Imaging detection of new HCCs in cirrhotic patients treated with different techniques: Comparison of conventional US,spiral CT,and 3-dimensional contrast-enhanced US with the Navigator technique (Nav 3D CEUS)

IntroductionThe commercially available Navigator system^© (Esaote, Italy) allows easy 3D reconstruction of a single 2D acquisition of contrast-enhanced US (CEUS) imaging of the whole liver (with volumetric correction provided by the electromagnetic device of the Navigator^©). The aim of our study was to compare the efficacy of this panoramic technique (Nav 3D CEUS) with that of conventional US and spiral CT in the detection of new hepatic lesions in patients treated for hepatocellular carcinoma (HCC).Materials and methodsFrom November 2006 to May 2007, we performed conventional US, Nav 3D CEUS, and spiral CT on 72 cirrhotic patients previously treated for 1 or more HCCs (M/F: 38/34; all HCV-positive; Child: A/B 58/14) (1 examination: 48 patients; 2 examinations: 20 patients; 3 examinations: 4 patients). Nav 3D CEUS was performed with SonoVue^© (Bracco, Milan, Italy) as a contrast agent and Technos MPX^© scanner (Esaote, Genoa, Italy). Sensitivity, specificity, diagnostic accuracy, and positive and negative predictive values (PPV and NPV, respectively) were evaluated. Differences between the techniques were assessed with the chi-square test (SPSS release-15).ResultsDefinitive diagnoses (based on spiral CT and additional follow-up) were: 6 cases of local recurrence (LocRecs) in 4 patients, 49 new nodules >2 cm from a treated nodule (NewNods) in 34 patients, and 10 cases of multinodular recurrence consisting of 4 or more nodules (NewMulti). The remaining 24 patients (22 treated for 1–3 nodules, 2 treated for >3 nodules) remained recurrence-free. Conventional US correctly detected 29/49 NewNods, 9/10 NewMultis, and 3/6 LocRecs (sensitivity: 59.2%; specificity: 100%; diagnostic accuracy: 73.6%; PPV: 100%; NPV: 70.1%). Spiral CT detected 42/49 NewNods plus 1 that was a false positive, 9/10 NewMultis, and all 6 LocRecs (sensitivity: 85.7%; specificity: 95.7%; diagnostic accuracy: 90.9%; PPV: 97.7%; NPV: 75.9%). 3D NAV results were: 46N (+9 multinodularN and 6 LR), 3 false-negatives, and one false-positive (sensitivity: 93.9; specificity: 97.9%; diagnostic accuracy: 95.6; PPV: 97.9; NPV: 93.9).Conclusions3D Nav CEUS is significantly better than US and very similar to spiral CT for detection of new HCCs. This technique revealed the presence of lesions that could not be visualized with spiral CT.     

Can Emergency Department Triage Nurses Appropriately Utilize the Ottawa Knee Rules to Order Radiographs?—An Implementation Trial

OBJECTIVE: To determine whether triage nurses can successfully interpret the Ottawa Knee Rule (OKR) and order knee radiographs according to the OKR. METHODS: This was a prospective implementation trial of a clinical decision rule, set in a suburban, community emergency department (ED), evaluating a convenience sample of ED patients aged > 17 years with acute knee injuries. Patients were excluded for altered mental status, distracting injuries, and knee lacerations. Triage nurses and attending emergency physicians (EPs) were trained in appropriate use of the OKR. The triage nurses evaluated eligible patients and radiographs were ordered according to their interpretation of the OKR. EPs who were initially blinded to the triage assessments also evaluated the patients. EPs could add an x-ray order if, according to their assessment of the OKR, one was indicated and a radiograph had not been ordered by the nurse. Nurses and EPs recorded their blinded assessments on standardized data collection instruments. Kappa values were calculated to assess interobserver agreement (IOA) between nurses and EPs; sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated as appropriate. RESULTS: One hundred three patients were enrolled; 53% were female; 10 fractures were identified (9.7%). The IOAs between the nurses and EPs for each of the criteria were moderate to almost perfect: age-0.94; fibular head tenderness-0.4; isolated patellar tenderness-0.68; inability to bend knee to 90 degrees-0.73; inability to bear weight-0.76. The IOA was moderate (0.52) for the overall interpretation of the OKR by nurses and EPs. Sensitivity of nurse interpretation of the OKR for fracture was 70%, specificity 33%, NPV 91%, PPV 10%. Sensitivity of EP interpretation of the OKR for fracture was 100%, specificity 25%, NPV 100%, PPV 13%. CONCLUSIONS: Triage nurses showed fair to good ability to appropriately apply the OKR to pre-order knee radiographs.     

Renal ultrasound

Renal US is one of several imaging modalities available to the EP in the evaluation of patients with acute urologic disorders. It offers excellent anatomic detail without exposure to radiation or contrast agents but is limited in its assessment of renal function. It is an important alternative to helical CT scanning for evaluating renal colic, especially in children and pregnant women. It has an important role in excluding bilateral renal obstruction as the cause of acute renal failure. It is likely that Doppler renal US also will take on a prominent role in the evaluation of renal vascular disorders. It already has become the standard of care in the management of renal transplant patients. Bedside emergency renal US performed and interpreted by EPs with limited training and experience is increasing in use and gaining acceptance. At present, the primary role of renal US is to identify hydronephrosis in patients with renal colic or acute renal failure but, in the future, its role likely will expand as technology advances and its use increases. In many patients, bedside renal US may obviate the need for further diagnostic workup and speed the diagnosis and treatment of an emergency patient.     

Liver Contrast-Enhanced Ultrasound Improves Detection of Liver Metastases in Patients with Pancreatic or Periampullary Cancer

The aim of this study is to provide a diagnostic performance evaluation of contrast-enhanced ultrasonography (CEUS) in detecting liver metastases in patients with suspected of pancreatic or periampullary cancer. Computed tomography (CT) is often insufficient for detection of liver metastases, but their presence plays a crucial role in the choice of therapy. Eighty-nine patients with suspected pancreatic or periampullary cancer were included in this prospective study with retrospective analysis. Patients underwent an abdominal CT and CEUS. Fifteen patients had liver metastases. The CT sensitivity was 73.3% (11/15), the specificity 93.2% (69/74), the positive predictive value (PPV) 68.8% (11/16) and the negative predictive value (NPV) 94.6% (69/73). Based on CEUS, the sensitivity was 80% (12/15), specificity 98.6% (73/74), PPV 92.3% (12/13) and NPV 96.1% (73/76). CEUS improved characterization of liver lesions in patients with suspected pancreatic or periampullary cancer compared with CT. CEUS can better detect benign liver lesions and distinguish false-positive or indeterminate CT results.     

Evaluation of right ventricular dysfunction and prediction of clinical outcomes in acute pulmonary embolism by chest computed tomography: comparisons with echocardiography

To evaluate the ability to identify right ventricular (RV) dysfunction, and to predict adverse outcomes of chest computed tomography (CT), we compared CT and echocardiography in acute pulmonary embolism patients. We analyzed 56 patients diagnosed by CT with acute pulmonary embolism, who underwent echocardiography within 48 h of CT scan from January 2004 to December 2008. From the CT scan, the ratio of RV diameter to left ventricular diameter (RVd/LVd), the presence of septal bowing and embolus location were determined. RVd/LVd (P < 0.001), septal bowing (P < 0.001) and proximal embolism (P = 0.016) were associated with echocardiographic RV hypokinesia. The odds ratio for adverse clinical outcomes was 19.2 for the combination of three CT parameters (RVd/LVd > 1, septal bowing, and proximal embolism), and 13.4 for RV hypokinesia (each P = 0.001). The positive predictive value (PPV) for adverse clinical outcomes for echocardiographic RV hypokinesia was 55.0%, and the negative predictive value (NPV) was 96.2%. The three-parameter combination predicted adverse clinical outcomes with a PPV of 54.5%, and a NPV of 94.1%. CT parameters including RV dysfunction were significantly associated with poor outcomes. Rapid risk stratification of patients with acute pulmonary embolism based on chest CT appears to be comparable with echocardiography, is clinically reliable, and may be useful in guiding management strategy.     

术前超声检查评估甲状腺微小乳头状癌颈部淋巴结转移的临床价值

目的探讨术前超声检查评估甲状腺微小乳头状癌颈部淋巴结转移的临床价值。方法回顾性分析2009年1月至2012年7月在上海交通大学医学院附属瑞金医院行超声检查并进行甲状腺手术的315例甲状腺微小乳头状癌患者。以术后石蜡切片病理检查结果作为金标准,计算术前超声评估颈部淋巴结有无转移、中央组淋巴结有无转移、颈侧组淋巴结有无转移的敏感度、特异度、阳性预测值及阴性预测值。结果共308例患者行淋巴结清扫,7例患者未行淋巴结清扫。术前超声检查评估颈部淋巴结有无转移的敏感度为38.8%（50/129）,特异度为96.1%（172/179）,阳性预测值为87.7%（50/57）,阴性预测值为68.5%（172/251）;术前超声检查评估中央组淋巴结有无转移的敏感度为31.4%（38/121）,特异度为96.7%（181/187）,阳性预测值为86.4%（38/44）,阴性预测值为68.5%（181/264）;术前超声检查评估颈侧组淋巴结有无转移的敏感度为80.9%（34/42）,特异度为98.4%（262/266）,阳性预测值为89.5%（34/38）,阴性预测值为97.0%（262/270）。以术前超声检查评估中央组淋巴结有无转移作为一项评估手段预测颈侧组有无转移,其敏感度为59.5%（25/42）,特异度为92.8%（247/266）。6.4%（17/264）的术前超声检查判断中央组淋巴结无转移患者中术后颈侧组淋巴结有转移。4.3%（8/187）的术中冰冻切片病理检查结果显示中央组淋巴结无转移患者中术后颈侧组淋巴结有转移。结论术前超声检查评估中央组淋巴结有无转移的敏感度较低,因此常规的中央组淋巴结清扫是必要的;术前超声检查评估颈侧组淋巴结有无转移的敏感度及特异度均较高,术前超声怀疑颈侧组淋巴结有转移的患者行颈侧区淋巴结的清扫是必要的。     

SPECT/CT肺灌注显像评价肺动脉球囊扩张成形术治疗慢性血栓栓塞性肺动脉高压效果

目的 以SPECT/CT肺灌注显像评价肺动脉球囊扩张成形术（BPA）治疗慢性血栓栓塞性肺动脉高压（CTEPH）的疗效。方法 对18例CTEPH患者分别于BPA前及其后1~3个月内行SPECT/CT肺灌注显像，以经导管肺动脉造影为标准，评价BPA前、后SPECT/CT探测肺段灌注缺损及灌注改善情况。结果 SPECT/CT肺灌注显像在BPA前探测肺段灌注缺损的敏感度、特异度、准确率、阳性预测值（PPV）及阴性预测值（NPV）分别为90.42%（302/334）、99.05%（418/422）、95.24%（720/756）、98.69%（302/306）及92.89%（418/450）；BPA后探测灌注改善的敏感度、特异度、准确率、PPV和NPV分别为77.78%（56/72）、80.00%（24/30）、78.43%（80/102）、90.32%（56/62）及60.00%（24/40）。结论 SPECT/CT肺灌注显像用于评价BPA治疗CTEPH后肺段灌注及改善具有较好临床价值。     

Should bedside sonography be used first to diagnose pneumothorax secondary to blunt trauma?

BACKGROUND.: Our purpose was to evaluate the effectiveness of bedside sonography (US) in the detection of pneumothorax secondary to blunt thoracic trauma. METHODS.: In this prospective study, 240 hemithoraces of 120 consecutive patients with multiple trauma were evaluated with chest radiographs (CXR) and bedside thoracic US for the diagnosis of pneumothorax. CT examinations were performed in 68 patients. Fifty-two patients who did not undergo CT examinations were excluded from the study. US examinations were performed independently at bedside by two radiologists who were not informed about CXR and CT findings. CXRs were interpreted by two radiologists who were unaware of the US and CT results. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR and US were calculated. RESULTS.: One hundred thirty-six hemithoraces were assessed in 68 patients. A total of 35 pneumothoraces were detected in 33 patients. On US, the diagnosis of pneumothorax was correct in 32 hemithoraces. In 98 hemithoraces without pneumothorax, US was normal. With US examination, there were three false-positive and three false-negative results. The sensitivity, specificity, positive predictive value, negative predictive value, and overall accuracy of US were 91.4%, 97%, 91.4%, 97%, and 97%, respectively. The sensitivity, specificity, positive predictive value, negative predictive value, and accuracy of CXR were 82.7%, 89.7%, 68.5%, 95%, and 89.5%, respectively. CONCLUSIONS.: Bedside thoracic US is an accurate method that can be used in trauma patients instead of CXR for the detection of pneumothorax.     

超声在甲状腺乳头状癌术前分期中的应用价值

目的探讨超声在甲状腺乳头状癌术前分期中的应用价值。 方法收集2014年1至11月中国医学科学院肿瘤医院经术后病理学检查证实的甲状腺乳头状癌患者121例,共169个病灶。分析肿瘤大小、甲状腺被膜外侵犯范围及颈部淋巴结转移等超声表现,根据国际抗癌联盟（UICC）（第6版）甲状腺癌分期标准行术前分期,并与病理分期对照,评估超声在甲状腺乳头状癌术前分期中的应用价值。 结果超声评估甲状腺被膜侵犯的敏感度、特异度、阳性预测值和阴性预测值分别为89.6%（60/67）、72.2%（39/54）、80.0%（60/75）、84.8%（39/46）。术前超声诊断T₁～T₄正确率分别为75.0%（36/48）、100%（1/1）、81.9%（59/72）、0。超声诊断颈部淋巴结转移的敏感度、特异度、阳性预测值和阴性预测值分别为47.5%（29/61）、90.0%（54/60）、82.9%（29/35）、62.8%（54/86）。 结论超声在甲状腺乳头状癌术前分期方面具有较高的应用价值,且有助于判断肿瘤甲状腺外侵犯范围及颈侧部淋巴结转移。     

Compression with a pocket-sized ultrasound device to diagnose proximal deep vein thrombosis

Introduction

Compression ultrasonography (CUS) is a validated technique for the diagnosis of deep venous thrombosis (DVT), but has never been studied with pocket-sized ultrasound device (PUD). The main objective of this study was to assess the diagnostic performance of CUS made by emergency physicians (EPs) using a PUD.

Is computed tomography tractography reliable in patients with anterior abdominal stab wounds?

Introduction

The current literature and guidelines recommend that determination of peritoneal violation is done first in cases of anterior abdominal stab wounds. The primary endpoint of this study was to determine the reliability of computed tomographic (CT) tractography to assess peritoneal violation in anterior abdominal stab wounds. The secondary endpoint is to compare local wound exploration between conventional CT and CT tractography in the evaluation of peritoneal violation.

超声诊断乳腺癌腋窝淋巴结转移的价值

目的 评价超声检查对检出乳腺癌腋窝淋巴结转移的价值.方法 1183例乳腺癌患者行乳腺和腋窝二维超声及彩色多普勒超声检查,超声诊断腋窝淋巴结分类与术后病理比较,计算超声分类的敏感性、特异性、阳性预期值、阴性预期值和诊断准确率.结果 超声检查腋窝转移淋巴结的敏感性为73.2%,特异性为94.0%,阳性预期值90.9%,阴性预期值81.0%,诊断准确率为84.6%.结论 超声判断腋窝转移淋巴结的准确率较高,但对直径＜10.0 mm转移淋巴结的敏感性有待提高.     

Chinese multi-center study of lung scintigraphy and CT pulmonary angiography for the diagnosis of pulmonary embolism

To evaluate diagnostic value of the PISA-PED and PIOPED II criteria for lung scintigraphy and compare it with CT pulmonary angiography (CTPA) for the detection of pulmonary embolism (PE). Five hundred and forty-four consecutive patients with suspected PE were enrolled. All patients underwent lung ventilation/perfusion (V/P) scan, chest radiography, and CTPA. Two readers used the PIOPED II criteria, and 2 used the PISA-PED criteria for the interpretation of lung scintigraphy. CTPA scans were interpreted by two experienced radiologists. Lung scintigraphy and CTPA were categorized as PE present, absent or non-diagnostic. PE was present in 321 of 544 patients. Using PIOPED II criteria, sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) were 85.1, 82.5, 88.1, and 78.4% respectively for V/P scan. Using PISA-PED criteria, sensitivity, specificity, PPV, and NPV were 86.0, 81.2, 86.8, and 80.1% respectively, and none was non-diagnostic. Sensitivity, specificity, PPV, and NPV were 81.7, 93.4, 94.9, and 77.3%, respectively for CTPA. PISA-PED interpretation has similar diagnostic accuracy to PIOPED II interpretation, does not have non-diagnostic scan, with lower cost and radiation, thus should be considered as a choice for patients with suspected PE.     

脑卒中后吞咽困难两种床旁评估量表比较

目的 比较标准乔咽功能评估(SSA)和苏格兰国家指南(SIG)两种临床床旁筛查量表对急性脑卒中后吞咽困难的诊断价值.方法 选取86例急性脑梗死住院患者,入院后48 h内即完成电视X线透视吞咽功能检查(VFSS)以及SSA和SIG评估,以VFSS结果为金标准比较两种床旁筛查方法的敏感性、特异性、阳性预测值、阴性预测值、阳性似然比、阴性似然比以及二者与VFSS的关联性.结果 SSA的敏感性为89.1%.特异性为75.0%,阳性预测值为0.804,阴性预测值为0.833,阳性似然比为3.56,阴性似然比为0.15;SIG筛查的结果分别为60.9%,82.5%,0.800,0.647,3.44,0.47,SSA的敏感性高于SIG(P＜0.05),SIG特异性稍高但差异无统计学意义(P＞0.05).二者与VFSS的一致性检验的Kappa值分别为0.648(95%CI:0.425,0.881).0.425(95%CI:0.219,0.631),均与VFSS相关(P＜0.05).结论 SSA和SIG均可用于脑卒中后吞咽困难的床旁评估.SSA敏感性高于SIG,更适于早期筛查;SIG的特异性稍高,有助于指导治疗和观察疗效,两者可结合使用.