title: Reliability of focused cardiac ultrasound by novice sonographer in preoperative anaesthetic assessment: an observational study.
abstract: BACKGROUND
  Use of preoperative echocardiography may help to identify patients with increased cardiac risk, who may benefit from modification of perioperative plan. The objective of our study was to evaluate the reliability of preoperative focused cardiac ultrasound (FoCUS) performed by an anaesthetist with basic ultrasound training and its impact on patient's management.
  
  
  METHODS
  The prospective observational study was conducted in 159 adult patients, scheduled for elective operations. Cardiac ultrasound was performed by one anaesthetist with a limited experience of FoCUS. A simple, mnemonic scheme was used for the final reporting of each study. The same scheme was used by a cardiologist who produced an independent report based on digital video loops stored in the machine memory. Anaesthetists in-charge made final perioperative plan. Comparative analysis of anaesthetist and cardiologist performed ultrasound report was made. The incidence of modification of initial perioperative plan resulting from FoCUS report was analyzed.
  
  
  RESULTS
  The average time required to complete the examination was 182 s 95% CI [173-190]. Images of quality adequate to answer all questions from the scheme were obtained in 97.5% (155/159) of patients. There was strong agreement between the anaesthetist and the cardiologist in 97.8% (2274/2325) of the examined categories. In two categories (global and regional left ventricle contractility impairment) statistically significant discrepancies between both diagnosticians were confirmed (p McNemar <0.04). When compared with the cardiologist's assessment the agreement of the anesthetist's diagnosis had sensitivity of 0.84, specificity 0.99, positive predictive value 0.78 and negative predictive value 0.99. Kappa statistics showed good agreement between both examining doctors (κ = 0.797). Based on ultrasound findings, the preliminary anaesthetic plan was changed in relation to 20.8% (33/159) of patients.
  
  
  CONCLUSIONS
  An anaesthetist with limited training in FoCUS can perform a reliable preoperative examination which alters the perioperative management.
authors.affiliation: 2nd Department of Anaesthesiology and Intensive Care, Warsaw Medical University, ul. Banacha 1A, 02-097, Warsaw, Poland. paul.andruszkiewicz@gmail.com.
authors.forename: Pawel
authors.initials: P
authors.lastname: Andruszkiewicz
authors.affiliation: The Department of Interventional Cardiology, John Paul 2nd Hospital, ul. Pradnicka 80, 31-202, Cracow, Poland. dorotasobczyk@yahoo.com.|The Department of Noninvasive Cardiovascular Diagnostics, John Paul 2nd Hospital, ul. Pradnicka 80, 31-202, Cracow, Poland. dorotasobczyk@yahoo.com.
authors.forename: Dorota
authors.initials: D
authors.lastname: Sobczyk
authors.affiliation: The Department of Noninvasive Cardiovascular Diagnostics, John Paul 2nd Hospital, ul. Pradnicka 80, 31-202, Cracow, Poland. izabelg@interia.pl.
authors.forename: Izabela
authors.initials: I
authors.lastname: Gorkiewicz-Kot
authors.affiliation: Institute of Cardiology, ul. Spartanska 1, 02-637, Warsaw, Poland. ikowalik@ikard.pl.
authors.forename: Ilona
authors.initials: I
authors.lastname: Kowalik
authors.affiliation: 2nd Department of Anaesthesiology and Intensive Care, Warsaw Medical University, ul. Banacha 1A, 02-097, Warsaw, Poland. remekgelo@poczta.onet.pl.
authors.forename: Remigiusz
authors.initials: R
authors.lastname: Gelo
authors.affiliation: 2nd Department of Anaesthesiology and Intensive Care, Warsaw Medical University, ul. Banacha 1A, 02-097, Warsaw, Poland. orest.stach@gmail.com.
authors.forename: Orest
authors.initials: O
authors.lastname: Stach
mesh_terms: D000776:Anesthesiology / Q000706:statistics & numerical data*; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015588:Observer Variation; D011044:Poland / Q000453:epidemiology; D011300:Preoperative Care / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity