title: Impact of pocket ultrasound use by internal medicine housestaff in the diagnosis of dyspnea.
abstract: BACKGROUND
  Recent reports demonstrate high diagnostic accuracy of lung ultrasound for evaluation of dyspnea. We assessed the feasibility of training internal medicine residents in lung ultrasound with a pocket ultrasound device.
  
  
  METHODS
  We performed a prospective, observational trial of residents performing lung ultrasound with a pocket ultrasound. Training consisted of two 90-minute sessions of didactics and supervised bedside performance. Two residents received an additional 2 weeks of training. Residents recorded a clinical diagnosis based on admission data. Following lung ultrasound performance, an ultrasound diagnosis was recorded integrating clinical and sonographic findings. Using receiver operating curve analysis, the area under the curve was calculated for both clinical diagnosis and ultrasound diagnosis using attending physician's final discharge diagnosis as the gold standard.
  
  
  RESULTS
  Five residents performed 69 exams. The AUC for ultrasound diagnosis was significantly higher than that for clinical diagnosis (0.87 vs 0.81, P < 0.01). AUCs increased using lung ultrasound for diagnoses as follows: chronic obstructive pulmonary disease (0.73-0.85, P = 0.06), acute pulmonary edema (0.85-0.89, P = 0.49), pneumonia (0.77-0.88, P = 0.01), and pleural effusions (0.76-0.96, P < 0.002).
  
  
  CONCLUSIONS
  Lung ultrasound performed by residents with a pocket ultrasound improved the diagnostic accuracy of dyspnea. Two residents undergoing extended training showed a total increase in diagnostic accuracy.
authors.affiliation: Division of Pulmonary and Critical Care, Mount Sinai Beth Israel, New York, New York.
authors.forename: Jason
authors.initials: J
authors.lastname: Filopei
authors.forename: Heather
authors.initials: H
authors.lastname: Siedenburg
authors.forename: Peter
authors.initials: P
authors.lastname: Rattner
authors.forename: Eri
authors.initials: E
authors.lastname: Fukaya
authors.forename: Pierre
authors.initials: P
authors.lastname: Kory
mesh_terms: D003937:Diagnosis, Differential; D004417:Dyspnea / Q000000981:diagnostic imaging; D006801:Humans; D007388:Internal Medicine; D007396:Internship and Residency; D019095:Point-of-Care Systems; D011446:Prospective Studies; D012372:ROC Curve; D012140:Respiratory Tract Diseases / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D014463:Ultrasonography