Influence of hand-carried ultrasound on bedside patient treatment decisions for consultative cardiology.
To test the hypothesis that hand-carried ultrasound (HCU) may influence patient treatment on consultative cardiology rounds, 235 patients who were hospitalized (aged 65 +/- 10 years) were studied. First, routine treatment decisions regarding diagnostic workup and therapy were made from patient history, physical examination, 12-lead electrocardiogram, and chart data. Second, a goal-directed HCU study was performed in <10 minutes focusing on left ventricular global and regional function, wall thickness, and presence of pericardial effusion, followed by a reassessment of treatment decisions. HCU data influenced treatment decisions in 149 patients (63%); 50% had a change in medical therapy and 22% had a change in their diagnostic workup (most with changes in both). In all, 12 patients (5%) had an immediate change in the decision for cardiac catheterization or pericardiocentesis. Overall agreement for the above findings with subsequent full-size system echocardiography ranged from 92% to 100% (kappa 0.91-0.96). Goal-directed HCU has the potential to influence bedside patient treatment decisions and expedite health care.
Gorcsan
John
J
University of Pittsburgh, Scaife Hall S-564, 200 Lothrop St, Pittsburgh, PA 15213, USA. gorcsanj@msx.upmc.edu
Pandey
Prasant
P
Sade
L Elif
LE
D000368:Aged; D002309:Cardiology; D003657:Decision Making; D004562:Electrocardiography; D004867:Equipment Design; D005260:Female; D006801:Humans; D017379:Hypertrophy, Left Ventricular / Q000000981:diagnostic imaging / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging / Q000503:physiopathology; D019095:Point-of-Care Systems; D012017:Referral and Consultation; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology