A pilot study of the clinical impact of hand-carried cardiac ultrasound in the medical clinic.
BACKGROUND
Small, hand-carried ultrasound devices have become widely available, making point-of-care echocardiograms (echos) accessible to all medical personnel as a means to augment and improve the increasingly inefficient physical examination. This study was designed to determine the clinical utility of hand-carried echo by medical residents in clinical decision making.


METHODS
Nine residents underwent brief, practical echo training to perform and interpret a limited hand-carried echo as an integral component of their office examination. The residents' hand-carried echo consisting of four basic views to define left ventricular (LV) function and wall thickness, valvular disease, and any pericardial effusions was compared to one performed by a level III echocardiographer.


RESULTS
Seventy-two consecutive medical clinic patients were enrolled with an average image acquisition time of 4.45 minutes. Residents obtained diagnostic images in 94% of the cases and interpreted them correctly 93% of the time. They correctly identified 92% of the major echo findings and 78% of the minor findings. Their diagnosis of LV dysfunction, valvular disease, and LV hypertrophy improved by 19%, 39%, and 14% with hand-carried echo compared to history and physical alone. Management decisions were reinforced in 76% and changed in 40% of patients with the use of hand-carried echo.


CONCLUSIONS
This study demonstrates that it is possible to train medical residents to perform an effective and reasonably accurate hand-carried echo during their physical examination, which can impact clinical management.
Croft
Lori B
LB
The Zena and Michael A. Wiener Cardiovascular Institute, Mount Sinai Medical Center, New York, NY 10029, USA. lori.croft@mssm.edu
Duvall
W Lane
WL
Goldman
Martin E
ME
D016009:Chi-Square Distribution; D002983:Clinical Competence; D003657:Decision Making; D004452:Echocardiography / Q000295:instrumentation*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D007388:Internal Medicine; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D010808:Physical Examination; D010865:Pilot Projects; D019095:Point-of-Care Systems; D012680:Sensitivity and Specificity