Feasibility of point-of-care echocardiography by internal medicine house staff.
OBJECTIVE
To determine whether internal medicine house staff with limited training in echocardiography can use point-of-care echocardiography to make simple, clinically important diagnoses.


BACKGROUND
Availability of small, portable ultrasound devices could make point-of-care echocardiography widely available. The training required to perform point-of-care echocardiography has not been established.


METHODS
Medical house staff participated in a 3-hour point-of-care echocardiography training program. Patients scheduled for standard echocardiography as part of clinical care underwent point-of-care echocardiography within 24 hours to assess four common clinically important diagnoses. Each standard echocardiogram was interpreted twice. Agreement (kappa) was calculated between point-of-care and standard echocardiography by using standard echocardiography as the gold standard and between the two interpretations of standard echocardiography.


RESULTS
Agreement (kappa) between point-of-care echocardiography and standard echocardiography was 75% (0.51) for left ventricular dysfunction (ejection fraction <55%), 79% (0.31) for moderate or severe mitral regurgitation, 92% (0.32) for aortic valve thickening or immobility, and 98% (0.51) for moderate or large pericardial effusion. Agreement between the two interpretations of standard echocardiography was 83% (0.63) for left ventricular dysfunction, 92% (0.68) for moderate or severe mitral regurgitation, 95% (0.62) for aortic valve thickening or immobility, and 97% (0.53) for moderate or large pericardial effusion.


CONCLUSIONS
Medical house staff with limited training in echocardiography can use point-of-care echocardiography to assess left ventricular function and pericardial effusion with moderate accuracy that is lower than that of standard echocardiography. Assessment of valvular disease and other diagnoses likely requires more training and/or experience in echocardiography.
Duke University Medical Center, Durham, NC, USA. alexa017@mc.duke.edu
John H
JH
Alexander
Eric D
ED
Peterson
Anita Y
AY
Chen
Tina M
TM
Harding
David B
DB
Adams
Joseph A
JA
Kisslo
D004452:Echocardiography; D004502:Education, Medical, Continuing; D005240:Feasibility Studies; D005260:Female; D006349:Heart Valve Diseases / Q000000981:diagnostic imaging; D006785:Hospitals, University; D006801:Humans; D007388:Internal Medicine / Q000193:education; D008297:Male; D008505:Medical Staff, Hospital / Q000193:education; D008875:Middle Aged; D009657:North Carolina; D010490:Pericardial Effusion / Q000000981:diagnostic imaging; D019095:Point-of-Care Systems; D029424:Pulmonary Disease, Chronic Obstructive / Q000000981:diagnostic imaging; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging