Diagnostic accuracy of hospitalist‐performed hand‐carried ultrasound echocardiography after a brief training program

Abstract

BACKGROUND:The duration of training needed for hospitalists to accurately perform hand‐carried ultrasound echocardiography (HCUE) is uncertain.OBJECTIVE:To determine the diagnostic accuracy of HCUE performed by hospitalists after a 27‐hour training program.DESIGN:Prospective cohort study.SETTING:Large public teaching hospital.PATIENTS:A total of 322 inpatients referred for standard echocardiography (SE) between March and May 2007.INTERVENTION:Blinded to SE results, attending hospitalist physicians performed HCUE within hours of SE.MEASUREMENTS:Diagnostic characteristics of HCUE as a test for 6 cardiac abnormalities assessed by SE: left ventricular (LV) systolic dysfunction; severe mitral regurgitation (MR); moderate or severe left atrium (LA) enlargement; moderate or severe LV hypertrophy; medium or large pericardial effusion; and dilatation of the inferior vena cava (IVC).RESULTS:A total of 314 patients underwent both SE and HCUE within a median time of 2.8 hours (25th to 75th percentiles, 1.4 to 5.1 hours). Positive and negative likelihood ratios for HCUE increased and decreased, respectively, the prior odds by 5‐fold or more for LV systolic dysfunction, severe MR regurgitation, and moderate or large pericardial effusion. Likelihood ratios changed the prior odds by 2‐fold or more for moderate or severe LA enlargement, moderate or severe LV hypertrophy, and IVC dilatation. Indeterminate HCUE results occurred in 2% to 6% of assessments.CONCLUSIONS:The diagnostic accuracy of HCUE performed by hospitalists after a brief training program was moderate to excellent for 6 important cardiac abnormalities. Journal of Hospital Medicine 2009;4:340–349. © 2009 Society of Hospital Medicine.

Admission inferior vena cava measurements are associated with mortality after hospitalization for acute decompensated heart failure

“…7 In recent years, multiple studies have emerged demonstrating that noncardiologists can perform focused cardiac ultrasound exams with high reproducibility and accuracy to guide management of patients with ADHF. [8][9][10][11][12][13][14] However, it is unknown whether IVC characteristics from a focused cardiac ultrasound exam performed by a noncardiologist can predict mortality of patients hospitalized with ADHF. The aim of this study was to assess whether a hospitalistperformed focused ultrasound exam to measure the IVC diameter at admission and discharge can predict mortality in a general medicine ward population hospitalized with ADHF.…”

Utilidad de la ecografía clínica en el diagnóstico del paciente con disnea

“…Se observa muy bien en el plano subxifoideo y no es necesario una curva de aprendizaje prolongada para su diagnóstico con fiabilidad [11][12][13][14][15][16][17][18][19] . El derrame pericárdico es moderado cuando su espesor supera los 10 mm y severo cuando es mayor de 20 mm (figura 13).…”

Point-of-Care Echocardiography in the Accountable Care Organization Era

“…Although a wide range of cart-based ultrasound systems is currently available, these systems have demonstrated adequate image quality to answer focused POC questions, even in patients with obesity or chronic obstructive pulmonary disease. 3,4 More recently, pocket-size ultrasound devices have been developed by various vendors. These devices have sizes approaching those of smart phones and are equipped with a battery and a single transducer.…”

“…The usefulness of these handheld devices is currently being assessed in clinical studies and has evoked a lively discussion regarding the benefits and potential perils of POC echocardiography performed by nonexperts and raised concerns regarding training, documentation, and reimbursement. 4,6,7 Current Role of Point-of-Care Echocardiography…”