title: Impact of Point-of-Care Ultrasound Examination on Triage of Patients With Suspected Cardiac Disease.
abstract: Complementing the physical examination with a point-of-care ultrasound study (POCUS) can improve patient triage. We aimed to study the impact of POCUS on the diagnosis and management of outpatients and hospitalized patients with suspected cardiac disease. In this multicenter study, a pocket-sized device was used to perform POCUS when the diagnosis or patient management was unclear based on anamnesis, physical examination, and basic diagnostic testing. Eighteen physicians (cardiac fellows 49%, cardiologists 30%, and echocardiographers 21%) performed physical examinations extended by POCUS on 207 patients (inpatients 83% and outpatients 17%). POCUS findings resulted in a change in the primary diagnosis in 14% of patients. In patients whose diagnosis remained unchanged, POCUS results reinforced the initial diagnosis in 48% of the cases. In 39% of the patients, the diagnostic plan was altered, including referral (16%) or deferral (23%) to other diagnostic techniques. Alteration in medical treatment (drug discontinuation or initiation) occurred in 11% of the patients, and in 7% POCUS results influenced the decision whether to perform a therapeutic procedure. Hospitalization or discharge was determined after POCUS in 11% of the patients. In conclusion, during patient triage, extension of the physical examination by POCUS can cause physicians to alter their initial diagnosis, resulting in an immediate change of diagnostic and therapeutic procedures. Based on POCUS results, physicians altered the diagnostic plan either by avoiding or referring patients to other diagnostic procedures in almost half of the studied population.
authors.affiliation: Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Sergio L
authors.initials: SL
authors.lastname: Kobal
authors.affiliation: Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Noah
authors.initials: N
authors.lastname: Liel-Cohen
authors.affiliation: Heart Institute, Kaplan Medical Center, Rehovot and Hadassah Medical School, The Hebrew University, Jerusalem, Israel.
authors.forename: Sarah
authors.initials: S
authors.lastname: Shimony
authors.affiliation: Division of Cardiology, Meir Medical Center, Kfar-Saba and Sackler Faculty of Medicine, Tel Aviv University, Israel.
authors.forename: Yoram
authors.initials: Y
authors.lastname: Neuman
authors.affiliation: Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Yuval
authors.initials: Y
authors.lastname: Konstantino
authors.affiliation: Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Efrat Mazor
authors.initials: EM
authors.lastname: Dray
authors.affiliation: Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel.
authors.forename: Itai
authors.initials: I
authors.lastname: Horowitz
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center and UCLA, Los Angeles, California. Electronic address: robert.siegel@cshs.org.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
mesh_terms: D005260:Female; D006331:Heart Diseases / Q000175:diagnosis*; D006801:Humans; D007297:Inpatients; D008297:Male; D008875:Middle Aged; D019095:Point-of-Care Systems; D015203:Reproducibility of Results; D014218:Triage / Q000379:methods*; D014463:Ultrasonography / Q000379:methods*