Diagnostic accuracy of hospitalist-performed hand-carried ultrasound echocardiography after a brief training program.
BACKGROUND
The duration of training needed for hospitalists to accurately perform hand-carried ultrasound echocardiography (HCUE) is uncertain.


OBJECTIVE
To determine the diagnostic accuracy of HCUE performed by hospitalists after a 27-hour training program.


METHODS
Prospective cohort study.


METHODS
Large public teaching hospital.


METHODS
A total of 322 inpatients referred for standard echocardiography (SE) between March and May 2007.


METHODS
Blinded to SE results, attending hospitalist physicians performed HCUE within hours of SE.


METHODS
Diagnostic characteristics of HCUE as a test for 6 cardiac abnormalities assessed by SE: left ventricular (LV) systolic dysfunction; severe mitral regurgitation (MR); moderate or severe left atrium (LA) enlargement; moderate or severe LV hypertrophy; medium or large pericardial effusion; and dilatation of the inferior vena cava (IVC).


RESULTS
A total of 314 patients underwent both SE and HCUE within a median time of 2.8 hours (25th to 75th percentiles, 1.4 to 5.1 hours). Positive and negative likelihood ratios for HCUE increased and decreased, respectively, the prior odds by 5-fold or more for LV systolic dysfunction, severe MR regurgitation, and moderate or large pericardial effusion. Likelihood ratios changed the prior odds by 2-fold or more for moderate or severe LA enlargement, moderate or severe LV hypertrophy, and IVC dilatation. Indeterminate HCUE results occurred in 2% to 6% of assessments.


CONCLUSIONS
The diagnostic accuracy of HCUE performed by hospitalists after a brief training program was moderate to excellent for 6 important cardiac abnormalities.
Lucas
Brian P
BP
Department of Medicine, Stroger Hospital of Cook County and Rush Medical College, Chicago, Illinois, USA. brian_lucas@rush.edu
Candotti
Carolina
C
Margeta
Bosko
B
Evans
Arthur T
AT
Mba
Benjamin
B
Baru
Joshua
J
Asbury
Joseph K
JK
Asmar
Abdo
A
Kumapley
Rudolf
R
Patel
Manish
M
Borkowsky
Shane
S
Fung
Sharon
S
Charles-Damte
Marjorie
M
D000328:Adult; D000368:Aged; D002983:Clinical Competence / Q000592:standards; D015331:Cohort Studies; D019719:Diagnostic Equipment / Q000592:standards; D004452:Echocardiography / Q000295:instrumentation* / Q000592:standards*; D005260:Female; D020445:Hospitalists / Q000193:education* / Q000592:standards*; D006801:Humans; D007318:Inservice Training / Q000592:standards*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis / Q000000981:diagnostic imaging