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Assessment of cardiac pathology by point-of-care ultrasonography performed by a novice examiner is comparable to the gold standard.

https://arctichealth.org/en/permalink/ahliterature105719
Source
Scand J Trauma Resusc Emerg Med. 2013;21:87
Publication Type
Article
Date
2013
Author
Christian Alcaraz Frederiksen
Peter Juhl-Olsen
Niels Holmark Andersen
Erik Sloth
Author Affiliation
Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. caf@ki.au.dk.
Source
Scand J Trauma Resusc Emerg Med. 2013;21:87
Date
2013
Language
English
Publication Type
Article
Keywords
Aged
Aortic Valve Stenosis - ultrasonography
Cardiology Service, Hospital
Clinical Competence - standards
Confidence Intervals
Denmark
Dilatation, Pathologic - ultrasonography
False Positive Reactions
Female
Heart Diseases - ultrasonography
Humans
Male
Middle Aged
Pericardial Effusion - ultrasonography
Point-of-Care Systems
Practice Guidelines as Topic
Single-Blind Method
Ventricular Dysfunction, Left - ultrasonography
Ventricular Dysfunction, Right - ultrasonography
Abstract
The aim of the study was to compare the diagnostic accuracy of point-of-care cardiac ultrasonography performed by a novice examiner against results from a specialist in cardiology with expert skills in echocardiography, with regard to the assessment of six clinically relevant cardiac conditions in a population of ward patients from the Department of Cardiology or the Department of Cardiothoracic Surgery.
Cardiac ultrasonography was performed by a novice examiner at the bedside and images were interpreted in a point-of-care context with dichotomous outcomes (yes/no). Six outcome categories were defined: 1) pericardial effusion (=10 mm), 2) left ventricular dilatation (=62 mm), 3) right ventricular dilatation (=42 mm or?=?left ventricular diameter), 4) left ventricular hypertrophy (=13 mm), 5) left ventricular failure (EF?=?40%), 6) aortic stenosis (maximum flow velocity =3 m/s). The examiner was blinded to the patients' medical history and results from previous echocardiographic examinations. Results from the interpreted point-of-care ultrasonography examination were compared with echocardiographic diagnosis made by a specialist in cardiology.
A total of 102 medical and surgical patients were included. Assessments were made in six categories totalling 612 assessments. There was agreement between the novice examiner and the specialist in 95.6% of the cases; overall sensitivity was 0.91 and specificity was 0.97. Positive predictive value was 0.92 and negative predictive value was 0.97. Kappa statistics showed good agreement between observers (?=0.88).
This study showed that a novice examiner was able to detect common and significant heart pathology in six different categories with good accuracy using POC ultrasonography.
Notes
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PubMed ID
24330752 View in PubMed
Less detail
Source
Circulation. 1996 Apr 1;93(7):1321-7
Publication Type
Article
Date
Apr-1-1996
Author
H. Feigenbaum
Source
Circulation. 1996 Apr 1;93(7):1321-7
Date
Apr-1-1996
Language
English
Publication Type
Article
Keywords
Analog-Digital Conversion
Animals
Autobiography
Echocardiography - history - instrumentation - methods
Echocardiography, Doppler - history - instrumentation
Equipment Design
Heart Diseases - ultrasonography
History, 19th Century
History, 20th Century
Humans
Japan
Pericardial Effusion - ultrasonography
Sweden
United States
Abstract
The evolution of echocardiography has been interesting and dramatic. The technology has grown and has become an integral part of the practice of cardiology. As with all technology, there are advantages and disadvantages. The principal disadvantage is the fact that education and training are imperative to provide high-quality examinations and proper interpretations. In addition, many of the diagnoses are still qualitative and subjective. The principal advantage is the amazing versatility of this technology. The wealth of information that can be provided both noninvasively with a transthoracic examination and invasively with either transesophageal or intravascular ultrasound is tremendous. The anatomic and physiological data provided frequently give definitive diagnoses. If performed properly and for the right reason, this test should be very cost effective and should be a major asset in the coming era of medical cost containment. There are many technological advances that should enhance this information. With technology such as digital recordings, it is hoped that the clinicians will have better access to these data and will be more comfortable in interacting with this important diagnostic tool.
PubMed ID
8641018 View in PubMed
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