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The diagnostic accuracy of pocket-size cardiac ultrasound performed by unselected residents with minimal training

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Abstract

Pocket-size imaging devices may represent a tool for fast initial cardiac screening in the emergency setting. Pocket-size cardiac ultrasound (PCU) examinations performed by experienced echocardiographers yield acceptable diagnostic accuracy compared to standard echocardiogram (SE). However, the success of this method when used by unselected non-cardiologists remains unexplored. The current study studies the diagnostic accuracy of PCU when used by unselected internal medicine residents with minimal training. All residents were given a 2-hour introductory course in PCU (Vscan) and reported PCU results for up to 15 predefined cardiac landmarks. These were arbitrarily divided into 3 priority groups, such that left ventricle (LV) and pericardium were of first priority. Diagnostic accuracy [sensitivity/specificity and negative/positive predictive values (PPV/NPV)] and agreement were evaluated using a subsequent SE as reference. During a 9.2 months period a total of 303 patients were included in the study, the majority on the basis of presenting with chest pain or suspected heart failure. In the pooled LV and pericardial (1st priority) data, sensitivity/specificity/PPV/NPV were 61/92/70/89 % respectively. Similar specificities and NPVs were observed for the 11 remaining indices, as were lower sensitivities and PPVs. The best PCU sensitivity (76 %) was attained for the assessment of LV wall motion abnormalities. Overall agreement was k = 0.50. PCU examination performed by internal medicine residents with minimal training could provide a suitable means of ruling out cardiac pathology, as reflected in the high specificities and NPVs. It is not, however, a satisfactory tool for identifying patients with various cardiac disorders.

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Acknowledgments

The authors thank Matthew McGee, Morbid Obesity Center, Vestfold Hospital Trust, for proofreading the manuscript.

Conflict of interest

The authors have declared that no competing interests exist.

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Authors and Affiliations

  1. Department of Cardiology, Vestfold Hospital Trust, Pb 2168, 3103, Tønsberg, Norway

    Vidar Ruddox, Jøran Hjelmesæth, Morten Bækkevar, Ingvild B. Norum & Jan Erik Otterstad

  2. University of Oslo, Oslo, Norway

    Vidar Ruddox, Thomas Muri Stokke & Thor Edvardsen

  3. Department of Cardiology, Oslo University Hospital, Rikshospitalet, Oslo, Norway

    Thomas Muri Stokke, Thor Edvardsen & Erlend Aune

  4. Morbid Obesity Center, Vestfold Hospital Trust, Tønsberg, Norway

    Jøran Hjelmesæth

  5. Department of Endocrinology, Institute of Clinical Medicine, Morbid Obesity and Preventive Medicine, University of Oslo, Oslo, Norway

    Jøran Hjelmesæth

Authors
  1. Vidar Ruddox
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  2. Thomas Muri Stokke
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  3. Thor Edvardsen
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  4. Jøran Hjelmesæth
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  5. Erlend Aune
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  6. Morten Bækkevar
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  7. Ingvild B. Norum
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  8. Jan Erik Otterstad
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Corresponding author

Correspondence to Vidar Ruddox.

Electronic supplementary material

Below is the link to the electronic supplementary material.

10554_2013_278_MOESM1_ESM.pdf

A flow chart showing those patients screened with PCU for the detection of a decreased left ventricle ejection fraction, subsequently found to be eligible for reference standard examination. (PDF 92 kb)

10554_2013_278_MOESM2_ESM.pdf

A flow chart showing those patients screened with PCU for detecting left ventricle dilation, subsequently found to be eligible for reference standard examination. (PDF 92 kb)

10554_2013_278_MOESM3_ESM.pdf

A flow chart showing those patients screened with PCU for the detection of left ventricle wall motion abnormalities, subsequently found to be eligible for reference standard examination. (PDF 93 kb)

10554_2013_278_MOESM4_ESM.pdf

A flow chart showing those patients screened with PCU for the detection of pericardial effusion, subsequently found to be eligible for reference standard examination. (PDF 91 kb)

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Ruddox, V., Stokke, T.M., Edvardsen, T. et al. The diagnostic accuracy of pocket-size cardiac ultrasound performed by unselected residents with minimal training. Int J Cardiovasc Imaging 29, 1749–1757 (2013). https://doi.org/10.1007/s10554-013-0278-7

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  • DOI: https://doi.org/10.1007/s10554-013-0278-7

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