Utility of hand-held devices in diagnosis and triage of cardiovascular emergencies. Observations during implementation of a PACS-based system in an acute aortic syndrome (AAS) network.
BACKGROUND
Prompt diagnosis and early referral to specialized centers is critical for patients presenting with cardiovascular emergencies, including acute aortic syndromes (AAS). Prior data has suggested that mobile access to imaging studies with hand-held devices can accelerate diagnosis and management.


OBJECTIVE
We conducted a study to determine the diagnostic accuracy of a hand-held device compared to conventional dedicated work-stations for diagnosing a spectrum of cardiovascular emergencies, predominantly acute aortic pathology.


METHODS
This study included 104 cases who underwent computed tomography (CT)-scan during "on-call'' hours between January, 2013 and August, 2014 for suspected AAS. Assessment was performed on a hand-held device independently by two readers using an iPhone5 connected via secure connection to web-based PACS servers. The subsequent interpretation from a dedicated workstation coupled with the diagnosis at the time of discharge was used as the reference standard for determining the presence or absence of an acute abnormality. Sensitivity and Specificity were calculated on a per patient basis.


RESULTS
Readers' sensitivity and specificity using the hand-held device to diagnose acute chest pathology were calculated. Hand-held device evaluation was determined to have a sensitivity of 85.2% and a specificity of 98.6% by reader A and a sensitivity of 96.3% and specificity of 100% by reader B. Of 103 cases interpreted by both readers, the readers agreed about the diagnosis in 98 cases (95.1%).


CONCLUSIONS
This study demonstrates that hand-held devices can be a potential useful tool to assist in diagnosis and triage of patients presenting with cardiovascular emergencies. Further studies are needed to assess the impact of screen size and resolution.
Internal Medicine Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: matarr@ccf.org.
Ralph
R
Matar
Imaging Institute and Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: Renapur@ccf.org.
Rahul
R
Renapurkar
Department of Quantitative Health Sciences, Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: obuchon@ccf.org.
Nancy
N
Obuchowski
Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: menonv@ccf.org.
Venu
V
Menon
Imaging Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: piraind@ccf.org.
David
D
Piraino
Imaging Institute and Heart and Vascular Institute, Cleveland Clinic, 9500 Euclid Avenue, Cleveland, OH 44195, USA. Electronic address: schoenp1@ccf.org.
Paul
P
Schoenhagen
D000208:Acute Disease; D039602:After-Hours Care; D000784:Aortic Dissection / Q000000981:diagnostic imaging; D017544:Aortic Aneurysm, Abdominal / Q000000981:diagnostic imaging; D001018:Aortic Diseases / Q000000981:diagnostic imaging* / Q000628:therapy; D001019:Aortic Rupture / Q000000981:diagnostic imaging; D001027:Aortography / Q000295:instrumentation*; D016507:Cardiology Service, Hospital; D040421:Cell Phone; D000067917:Cloud Computing; D004632:Emergency Medical Services; D004867:Equipment Design; D005240:Feasibility Studies; D006801:Humans; D063731:Mobile Applications; D061330:Multidetector Computed Tomography / Q000295:instrumentation*; D015588:Observer Variation; D011237:Predictive Value of Tests; D011379:Prognosis; D011655:Pulmonary Embolism / Q000000981:diagnostic imaging; D011857:Radiographic Image Interpretation, Computer-Assisted / Q000295:instrumentation*; D015203:Reproducibility of Results; D013577:Syndrome; D014218:Triage; D057188:Workflow
Acute aortic syndrome; Aortic dissection; Computed tomography; Hand-held device; Pulmonary embolism