The impact of evolving hand-carried echocardiographic technology on outpatient physical examination accuracy in pediatric cardiology.
BACKGROUND
Cardiac auscultory skills are declining. Hand-carried ultrasound (HCU) has been proposed as a method to enhance diagnostic accuracy of the physical examination (PE). However, features of HCU devices are varied.


OBJECTIVE
The aim of this study was to compare the diagnostic accuracies of an experienced pediatric cardiac PE alone vs. the PE combined with the assistance of an HCU device when using 2 HCU devices with different capabilities. The results were compared with conventional echo as the reference standard.


METHODS
All outpatients seen by a single pediatric cardiologist underwent physical examination and HCU. Two HCU devices were compared. The first HCU device (HCU-1) had limited options with only 2-dimensional echo, limited Doppler, and a single transducer frequency (2.5 MHz). The second HCU device (HCU-2) was a unit with greater transducer choices and a wider variety of applications. A single echocardiologist performed the PEs & HCUs. Conventional echoes were performed by a pediatric sonographer and interpreted by a second pediatric echocardiologist. Examination accuracies centered on 3 broad areas including: cardiac shunts, valvular insufficiency, and valvular anatomy. The accuracy of the PE alone was compared with the accuracy of the combined PE & HCU-1 vs. PE & HCU-2.


RESULTS
Thirty patients total (3 months-19 years, 4-82 kg) were evaluated. Eighteen were examined with HCU-1 and 12 were examined with HCU-2. The accuracy of the combined PE & HCU-1 did not improve accuracy over the PE alone. However, the accuracy of the combined PE & HCU-2 was greater than the PE alone.


CONCLUSIONS
Use of a limited HCU device does not improve diagnostic accuracy over an experienced PE alone and may actually worsen diagnostic accuracy in some cases. However, the improvements in newer HCU devices may enhance diagnostic accuracy over the PE alone, even for experienced physicians.
Ippisch
Holly M
HM
Division of Cardiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio 45229, USA. Holly.Ippisch@ cchmc.org
Kimball
Thomas R
TR
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography / Q000592:standards; D004867:Equipment Design; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D007223:Infant; D010808:Physical Examination / Q000592:standards