title: Assessment of cardiac pathology by point-of-care ultrasonography performed by a novice examiner is comparable to the gold standard.
abstract: BACKGROUND
  The aim of the study was to compare the diagnostic accuracy of point-of-care cardiac ultrasonography performed by a novice examiner against results from a specialist in cardiology with expert skills in echocardiography, with regard to the assessment of six clinically relevant cardiac conditions in a population of ward patients from the Department of Cardiology or the Department of Cardiothoracic Surgery.
  
  
  METHODS
  Cardiac ultrasonography was performed by a novice examiner at the bedside and images were interpreted in a point-of-care context with dichotomous outcomes (yes/no). Six outcome categories were defined: 1) pericardial effusion (≥10 mm), 2) left ventricular dilatation (≥62 mm), 3) right ventricular dilatation (≥42 mm or ≥ left ventricular diameter), 4) left ventricular hypertrophy (≥13 mm), 5) left ventricular failure (EF ≤ 40%), 6) aortic stenosis (maximum flow velocity ≥3 m/s). The examiner was blinded to the patients' medical history and results from previous echocardiographic examinations. Results from the interpreted point-of-care ultrasonography examination were compared with echocardiographic diagnosis made by a specialist in cardiology.
  
  
  RESULTS
  A total of 102 medical and surgical patients were included. Assessments were made in six categories totalling 612 assessments. There was agreement between the novice examiner and the specialist in 95.6% of the cases; overall sensitivity was 0.91 and specificity was 0.97. Positive predictive value was 0.92 and negative predictive value was 0.97. Kappa statistics showed good agreement between observers (κ=0.88).
  
  
  CONCLUSIONS
  This study showed that a novice examiner was able to detect common and significant heart pathology in six different categories with good accuracy using POC ultrasonography.
authors: Department of Cardiology, Aarhus University Hospital, Skejby, Denmark. caf@ki.au.dk.
authors: Christian Alcaraz
authors: CA
authors: Frederiksen
authors: Peter
authors: P
authors: Juhl-Olsen
authors: Niels Holmark
authors: NH
authors: Andersen
authors: Erik
authors: E
authors: Sloth
mesh_terms: D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging; D016507:Cardiology Service, Hospital; D002983:Clinical Competence / Q000592:standards*; D016001:Confidence Intervals; D003718:Denmark; D004108:Dilatation, Pathologic / Q000000981:diagnostic imaging; D005189:False Positive Reactions; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000000981:diagnostic imaging; D019095:Point-of-Care Systems; D017410:Practice Guidelines as Topic; D016037:Single-Blind Method; D014463:Ultrasonography; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging