title: Focused cardiac ultrasound by unselected residents-the challenges.
abstract: Focus Cardiac Ultrasound (FoCUS) performed by internal medicine residents on call with 2 h of training can provide a means for ruling out cardiac disease, but with poor sensitivity. The purpose of the present study was to evaluate diagnostic usefulness as well as diagnostic accuracy of FoCUS following 4 h of training.
  
  
  
  All residents on call were given a 4-h training course with an additional one-hour training course after 6 months. They were asked to provide a pre- and post-FoCUS diagnosis, with the final diagnosis at discharge as reference.
  
  
  
  During a 7 month period 113 FoCUS examinations were reported; after 53 were excluded this left 60 for evaluation with a standard echocardiogram performed on average 11.5 h after FoCUS. Examinations were performed on the basis of chest pain and dyspnoea/edema. The best sensitivity was found in terms of the detection of reduced left ventricular (LV) ejection fraction (EF) (92%), LV dilatation (85%) and pericardial effusion (100%). High values were noted for negative predictive values, although false positives were seen. A kappa > 0.6 was observed for reduced LVEF, right ventricular area fraction and dilatation of LV and left atrium. In 48% of patients pre- and post-FoCUS diagnoses were identical and concordant with the final diagnosis. Importantly, in 30% examinations FoCUS correctly changed the pre-FoCUS diagnosis.
  
  
  
  A FoCUS protocol with a 4-h training program gained clinical usefulness in one third of examinations. False positive findings represented the major challenge.
authors.affiliation: Department of cardiology, Vestfold Hospital Trust, Po. Box 2168, N3103, Tønsberg, Norway. vidar.ruddox@siv.no.|Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway. vidar.ruddox@siv.no.
authors.forename: Vidar
authors.identifier: 0000-0001-7760-1590
authors.initials: V
authors.lastname: Ruddox
authors.affiliation: Department of cardiology, Vestfold Hospital Trust, Po. Box 2168, N3103, Tønsberg, Norway.|Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Ingvild Billehaug
authors.initials: IB
authors.lastname: Norum
authors.affiliation: Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Thomas Muri
authors.initials: TM
authors.lastname: Stokke
authors.affiliation: Department of cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway.|Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
authors.forename: Thor
authors.initials: T
authors.lastname: Edvardsen
authors.affiliation: Department of cardiology, Vestfold Hospital Trust, Po. Box 2168, N3103, Tønsberg, Norway.
authors.forename: Jan Erik
authors.initials: JE
authors.lastname: Otterstad
mesh_terms: D039602:After-Hours Care / Q000706:statistics & numerical data*; D000368:Aged; D000369:Aged, 80 and over; D002309:Cardiology / Q000193:education; D002983:Clinical Competence / Q000706:statistics & numerical data*; D004452:Echocardiography / Q000706:statistics & numerical data*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D006801:Humans; D007318:Inservice Training / Q000706:statistics & numerical data*; D007396:Internship and Residency / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D009664:Norway / Q000453:epidemiology; D015995:Prevalence; D011871:Radiology / Q000193:education; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D013318:Stroke Volume