102 Pocket-size hand-held cardiac ultrasound in the hands of students and junior doctors: does it improve diagnostic accuracy over history, physical examination and ECG?

Background Even though patient history taking and physical examination remain the foundations of patient evaluation in daily clinical practise, there has been a decline in the accuracy of the later. Pocket hand held echocardiographic (PHHE) devices have recently been introduced and could potentially improve diagnostic accuracy in the hands of non-cardiologists. The amount of training required to achieve optimal results remains a matter of debate. Aim We hypothesised that use of PHHE after limited training, can improve diagnostic accuracy even in the hands of medical students and inexperienced physicians. Methods Five final year medical students and 3 junior doctors without prior echocardiographic experience participated in a standardised 2-h PHHE bed-side training program. Subsequently they assessed 122 patients (history taking, physical examination, ECG interpretation and PHHE). Their physical and echocardiographic findings were compared to those of a transthoracic echocardiography accredited cardiologist. Results A total of 122 V-scans were performed of which 64 (53%) by final-year medical students and 58 (47%) by junior doctors. Mean age of the participants was 64±16.1 years and 87 (71.3%) were male. Out of 122 patients, 69 (56.6%) had LV dysfunction, 16 (13.1%) had RV dysfunction, 74 (52.5%) had valvular abnormalities, 5 (4.1%) had prosthetic valves, 6 (4.9%) had pericardial effusions and 4 (3.3%) ascending aorta disease. Mean±SD for diagnostic accuracy (maximum=1) after history, physical examination and ECG interpretation was 0.53±0.19 whereas addition of PHHE increased its value to 0.85±0.2 (Z=−8.964, p Conclusions In the current study use of PHHE after brief, bed-side training greatly improved the diagnostic accuracy of medical students and junior doctors, over and above history, physical examination and ECG interpretation.