title: Incremental Value of Pocket-Sized Echocardiography in Addition to Physical Examination during Inpatient Cardiology Evaluation: A Multicenter Italian Study (SIEC).
abstract: BACKGROUND
  We prospectively assessed the incremental value of a pocket-sized echocardiography (PSE) device during cardiology consultations, in addition to physical examination, ECG reading, and chest x-ray.
  
  
  METHODS
  A total of 443 consecutive patients (53% men), referred for bedside consultations, underwent physical examination, ECG, and CXR, followed by PSE examination. The physician completed a detailed questionnaire (clinical and echocardiographic data, scanning time, abnormal results). Receiver operating characteristic (ROC) curve analysis was generated to test the predictive discrimination value of the different methods. The incremental value of PSE examination compared to clinical visit alone or combined with ECG results was expressed as a global chi-square value.
  
  
  RESULTS
  The PSE examination did not influence the definitive diagnosis in only 23.5% of cases, while 25.3% of the diagnoses were confirmed and verified by PSE. The clinical diagnosis was enriched by PSE in 21.9% of cases, and the diagnosis was changed in 26.2%. The area under curve (AUC) of physical examination + ECG results (sensitivity: 80%; specificity: 67%) was significantly higher than physical examination alone (sensitivity: 75%; specificity: 62%) (P < 0.0002), and the AUC of PSE results (sensitivity: 88%; specificity: 86%) was significantly higher than physical examination + ECG results (P < 0.0001). The PSE results, combined with clinical and ECG results, had a significant incremental diagnostic value during cardiology consultation when compared to the clinical visit alone or with ECG results (P < 0.0001).
  
  
  CONCLUSIONS
  PSE had an incremental diagnostic value during bedside cardiology consultation, increasing the number of appropriate diagnoses and reducing the routine use of echocardiography.
authors: University Cardio-angiology Departmental Section, Cisanello Hospital, AOUP, Pisa, Italy.
authors: Vitantonio
authors: V
authors: Di Bello
authors: Villa Sofia Hospital, Palermo, Italy.
authors: Salvatore
authors: S
authors: La Carrubba
authors: University Cardio-angiology Departmental Section, Cisanello Hospital, AOUP, Pisa, Italy.
authors: Lorenzo
authors: L
authors: Conte
authors: University Cardio-angiology Departmental Section, Cisanello Hospital, AOUP, Pisa, Italy.
authors: Iacopo
authors: I
authors: Fabiani
authors: Cardiology Unit, S. Giovanni Evangelista Hospital, Tivoli, Italy.
authors: Alfredo
authors: A
authors: Posteraro
authors: Preventive and Rehabilitative Cardiology, Pordenone Hospital, Pordenone, Italy.
authors: Francesco
authors: F
authors: Antonini-Canterin
authors: University Cardio-angiology Departmental Section, Cisanello Hospital, AOUP, Pisa, Italy.
authors: Valentina
authors: V
authors: Barletta
authors: University Cardio-angiology Departmental Section, Cisanello Hospital, AOUP, Pisa, Italy.
authors: Irene
authors: I
authors: Nicastro
authors: Cardiology, San Salvatore Hospital, Pesaro, Italy.
authors: Egidio
authors: E
authors: Mariotti
authors: Department of Cardiology, Monaldi Hospital, Naples, Italy.
authors: Sergio
authors: S
authors: Severino
authors: Department of Cardiology, Monaldi Hospital, Naples, Italy.
authors: Pio
authors: P
authors: Caso
authors: UOC Rehabilitative Cardiology, Reggio Calabria, Italy.
authors: Frank
authors: F
authors: Benedetto
authors: Cardiology and Cardiovascular Physiopathology, University of Perugia, Perugia, Italy.
authors: Ketty
authors: K
authors: Savino
authors: Clinical and Experimental Medicine Department, University of Messina, Messina, Italy.
authors: Scipione
authors: S
authors: Carerj
mesh_terms: D000368:Aged; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging*; D004452:Echocardiography / Q000295:instrumentation*; D004562:Electrocardiography; D005260:Female; D006801:Humans; D007558:Italy; D008297:Male; D010808:Physical Examination; D019095:Point-of-Care Systems; D011446:Prospective Studies; D013902:Radiography, Thoracic; D012680:Sensitivity and Specificity; D011795:Surveys and Questionnaires
keywords: cardiology physical examination; echocardiography; electrocardiography; handheld ultrasound; pocket-sized echocardiography