Diagnostic accuracy of hospitalist‐performed hand‐carried ultrasound echocardiography after a brief training program
2009
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.
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