title: Diagnostic influence of routine point-of-care pocket-size ultrasound examinations performed by medical residents.
abstract: OBJECTIVE
  We aimed to investigate the potential benefit of adding goal-directed ultrasound examinations performed by on-call medical residents using a pocket-size imaging device in patients admitted to a medical department.
  
  
  METHODS
  A total of 992 emergency admissions to the medical department at a nonuniversity hospital in Norway were included. Patients admitted on dates with an on-call medical resident randomized to use a pocket-size imaging device were eligible for pocket-size cardiac and abdominal ultrasound examinations or standard care. The cardiac examination included estimation of right and left ventricular sizes and global systolic function and regional left ventricular systolic function, evaluation for pleural and pericardial effusion, and valvular disease. The abdominal examination looked for signs of gross abnormalities of the liver, gallbladder, abdominal aorta, inferior vena cava, and urinary system. Six of 12 medical residents with limited ultrasound experience were randomized to perform the examinations. Diagnostic corrections were made, and findings were confirmed by reference standard diagnostics.
  
  
  RESULTS
  A total of 199 patients were examined. Median times used were 5.7 minutes for the cardiac examination and 4.7 minutes for the abdominal examination. In 13 patients (6.5%), the examination resulted in a major change in the primary diagnosis. In 21 patients (10.5%), the diagnosis was verified, and in 48 (24.0%), an additional important diagnosis was made.
  
  
  CONCLUSIONS
  By implementing pocket-size ultrasound examinations that took less than 11 minutes to the usual care, we corrected, verified, or added important diagnoses in more than 1 of 3 emergency medical admissions. Point-of-care examinations with a pocket-size imaging device increased medical residents' diagnostic accuracy and capability.
authors: Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway (G.N.A., T.G., K.S., J.O.K., Ø.O., H.D.); Medical Imaging Laboratory (G.N.A., O.C.M., B.O.H., H.D.), Department of Circulation and Medical Imaging (G.N.A., O.C.M., B.O.H., H.D.), and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; and Clinic of Cardiology, St Olav Trondheim University Hospital, Trondheim, Norway (O.C.M., B.O.H.). garrett.andersen@gmail.com.
authors: Garrett N
authors: GN
authors: Andersen
authors: Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway (G.N.A., T.G., K.S., J.O.K., Ø.O., H.D.); Medical Imaging Laboratory (G.N.A., O.C.M., B.O.H., H.D.), Department of Circulation and Medical Imaging (G.N.A., O.C.M., B.O.H., H.D.), and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; and Clinic of Cardiology, St Olav Trondheim University Hospital, Trondheim, Norway (O.C.M., B.O.H.).
authors: Torbjørn
authors: T
authors: Graven
authors: Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway (G.N.A., T.G., K.S., J.O.K., Ø.O., H.D.); Medical Imaging Laboratory (G.N.A., O.C.M., B.O.H., H.D.), Department of Circulation and Medical Imaging (G.N.A., O.C.M., B.O.H., H.D.), and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; and Clinic of Cardiology, St Olav Trondheim University Hospital, Trondheim, Norway (O.C.M., B.O.H.).
authors: Kyrre
authors: K
authors: Skjetne
authors: Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway (G.N.A., T.G., K.S., J.O.K., Ø.O., H.D.); Medical Imaging Laboratory (G.N.A., O.C.M., B.O.H., H.D.), Department of Circulation and Medical Imaging (G.N.A., O.C.M., B.O.H., H.D.), and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; and Clinic of Cardiology, St Olav Trondheim University Hospital, Trondheim, Norway (O.C.M., B.O.H.).
authors: Ole C
authors: OC
authors: Mjølstad
authors: Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway (G.N.A., T.G., K.S., J.O.K., Ø.O., H.D.); Medical Imaging Laboratory (G.N.A., O.C.M., B.O.H., H.D.), Department of Circulation and Medical Imaging (G.N.A., O.C.M., B.O.H., H.D.), and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; and Clinic of Cardiology, St Olav Trondheim University Hospital, Trondheim, Norway (O.C.M., B.O.H.).
authors: Jens O
authors: JO
authors: Kleinau
authors: Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway (G.N.A., T.G., K.S., J.O.K., Ø.O., H.D.); Medical Imaging Laboratory (G.N.A., O.C.M., B.O.H., H.D.), Department of Circulation and Medical Imaging (G.N.A., O.C.M., B.O.H., H.D.), and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; and Clinic of Cardiology, St Olav Trondheim University Hospital, Trondheim, Norway (O.C.M., B.O.H.).
authors: Øystein
authors: Ø
authors: Olsen
authors: Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway (G.N.A., T.G., K.S., J.O.K., Ø.O., H.D.); Medical Imaging Laboratory (G.N.A., O.C.M., B.O.H., H.D.), Department of Circulation and Medical Imaging (G.N.A., O.C.M., B.O.H., H.D.), and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; and Clinic of Cardiology, St Olav Trondheim University Hospital, Trondheim, Norway (O.C.M., B.O.H.).
authors: Bjørn O
authors: BO
authors: Haugen
authors: Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway (G.N.A., T.G., K.S., J.O.K., Ø.O., H.D.); Medical Imaging Laboratory (G.N.A., O.C.M., B.O.H., H.D.), Department of Circulation and Medical Imaging (G.N.A., O.C.M., B.O.H., H.D.), and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; and Clinic of Cardiology, St Olav Trondheim University Hospital, Trondheim, Norway (O.C.M., B.O.H.).
authors: Håvard
authors: H
authors: Dalen
mesh_terms: D000005:Abdomen / Q000000981:diagnostic imaging; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004867:Equipment Design; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging; D006801:Humans; D007396:Internship and Residency; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D014463:Ultrasonography / Q000295:instrumentation*; D055815:Young Adult
keywords: diagnosis; echocardiography; general medicine; health economics; point-of-care ultrasound