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Pocket-sized echocardiography for screening structural heart disease: diagnostic accuracy and cost-effectiveness for population-based studies. Cardiol Young 2020; 30:197-204. [PMID: 32605675 DOI: 10.1017/s1047951119003111] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The standard transthoracic echocardiography has some limitations in emergent and community-based situations. The emergence of pocket-sized ultrasound has led to influential advancements. METHODS In this prospective study, in the hospital-based phase, children with suspected structural heart diseases were enrolled. In the school-based phase, healthy children were randomly selected from six schools. All individuals were examined by experienced operators using both the standard and the pocket-sized echocardiography. RESULTS A total of 73 individuals with a mean age of 9.9 ± 3.2 years in the hospital-based cohort and 143 individuals with a mean age of 12.8 ± 2.9 years in the school-based cohort were examined. The agreements between the standard and the pocket-sized echocardiography were good or excellent for major CHDs in both cohorts (κ statistics > 0.61). Among valvular pathologies, agreements for tricuspid and pulmonary valves' regurgitation were moderate among school-based cohorts (0.56 [95% confidence interval 0.12-1] and 0.6 [95% confidence interval 0.28-0.91], respectively). The agreements for tricuspid and pulmonary valves' regurgitation were excellent (>0.9) among hospital-based population. Other values for valvular findings were good or excellent. The overall sensitivity and specificity were 87.5% (95% confidence interval 47.3-99.7) and 93.8% (95% confidence interval 85-98.3) among the hospital-based individuals, respectively, and those were 88% (95% confidence interval 77.8-94.7) and 68.4% (95% confidence interval 56.7-78.6) among the school-based individuals, respectively. The cost of examination was reduced by approximately 70% for an individual using the pocket-sized device. CONCLUSIONS When interpreted by experienced operators, the pocket-sized echocardiography can be used as screening tool among school-aged population.
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Acheampong B, Parra DA, Aliyu MH, Moon TD, Soslow JH. Smartphone interfaced handheld echocardiography for focused assessment of ventricular function and structure in children: A pilot study. Echocardiography 2019; 37:96-103. [PMID: 31879998 DOI: 10.1111/echo.14575] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2019] [Revised: 11/29/2019] [Accepted: 12/10/2019] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Miniaturized echocardiographic machines improve availability and portability and can be particularly useful for underserved and resource-limited settings. The goal of this study was to compare left ventricular fractional shortening (FS) and left ventricular ejection fraction (LVEF) obtained by a newer handheld echo (HHE) machine to standard transthoracic echocardiogram (TTE) in children. METHODS Pediatric outpatients (Birth-18 years) undergoing TTE were prospectively enrolled. HHE protocol included 2D and M-mode images from the parasternal long, short, and apical-4 chamber views. HHE and TTE measurements were reviewed for agreement. Kappa statistic was used to analyze qualitative indices while FS and LVEF were analyzed with Lin's concordance correlation coefficient (CCC) and Bland-Altman limits of agreement (loa). RESULTS Sixty children were enrolled; 55 were included in the quantitative analysis. Mean age was 7.5 ± 5.5 years; 67% males; median HHE image acquisition duration was 2.3(1-5) minutes. Fractional shortening and EF by HHE showed good agreement with TTE [CCC = 0.82, 95%CI (0.73,0.90), mean bias -3.18%, loa (-7.00,6.44%) vs CCC = 0.81 (0.72,0.90), mean bias -0.87%, loa (-6.94,5.17%], respectively. In children ≤5 years, HHE FS (n = 20) and EF (n = 21) agreed with TTE measurement [0.59 (0.31, 0.88), mean bias 0.30%, loa (-8.5, 9.1%); 0.79 (0.63, 0.96), mean bias 0.10%, loa (-5.99, 6.14)]. Kappa values for RV size, function, and LV function were 1.00 (P < .05); 0.75 for LV size (P < .05) and 0.66 for pericardial effusion (P < .05). CONCLUSION Handheld echo demonstrates good correlation with standard TTE for focused assessment of ventricular chamber sizes and function in children.
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Affiliation(s)
- Benjamin Acheampong
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee.,Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee
| | - David A Parra
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Muktar H Aliyu
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee.,Department of Health Policy, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Troy D Moon
- Vanderbilt Institute for Global Health, Vanderbilt University Medical Center, Nashville, Tennessee.,Division of Pediatric Infectious Diseases, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Jonathan H Soslow
- Division of Pediatric Cardiology, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee
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Nilsson G, Söderström L, Alverlind K, Samuelsson E, Mooe T. Hand-held cardiac ultrasound examinations performed in primary care patients by nonexperts to identify reduced ejection fraction. BMC MEDICAL EDUCATION 2019; 19:282. [PMID: 31345207 PMCID: PMC6659293 DOI: 10.1186/s12909-019-1713-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/07/2019] [Accepted: 07/16/2019] [Indexed: 06/10/2023]
Abstract
BACKGROUND Early identification of patients with reduced left ventricular ejection fraction (LVEF) could facilitate the care of patients with suspected heart failure (HF). We examined if (1) focused cardiac ultrasound (FCU) performed with a hand-held device (Vscan 1.2) could identify patients with LVEF < 50%, and (2) the distribution of HF types among patients with suspected HF seen at primary care clinics. METHODS FCU performed by general practitioners (GPs)/GP registrars after a training programme comprising 20 supervised FCU examinations were compared with the corresponding results from conventional cardiac ultrasound by specialists. The agreement between groups of estimated LVEF < 50%, after visual assessment of global left ventricular function, was compared. Types of HF were determined according to the outcomes from the reference examinations and serum levels of natriuretic peptides (NT-proBNP). RESULTS One hundred patients were examined by FCU that was performed by 1-4 independent examiners as well as by the reference method, contributing to 140 examinations (false positive rate, 19.0%; false negative rate, 52.6%; sensitivity, 47.4% [95% confidence interval [CI]: 27.3-68.3]; specificity, 81.0% [95% CI: 73.1-87.0]; Cohen's κ measure for agreement = 0.22 [95% CI: 0.03-0.40]). Among patients with false negative examinations, 1/7 had HF with LVEF < 40%, while the others had HF with LVEF 40-49% or did not meet the full criteria for HF. In patients with NT-proBNP > 125 ng/L and fulfilling the criteria for HF (68/94), HF with preserved LVEF (≥50%) predominated, followed by mid-range (40-49%) or reduced LVEF (< 40%) HF types (53.2, 11.7 and 7.4%, respectively). CONCLUSIONS There was poor agreement between expert examiners using standard ultrasound equipment and non-experts using a handheld ultrasound device to identify patients with reduced LVEF. Asides from possible shortcomings of the training programme, the poor performance of non-experts could be explained by their limited experience in identifying left ventricular dysfunction because of the low percentage of patients with HF and reduced ejection fraction seen in the primary care setting. TRIAL REGISTRATION The study was registered at ClinicalTrials.gov (NCT02939157). Registered 19 October 2016.
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Affiliation(s)
- G. Nilsson
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
- Department of Public Health and Clinical Medicine, Unit of Research, Education and Development-Östersund Hospital, Box 654, 83127 Östersund, Sweden
| | - L. Söderström
- Unit of Research, Education and Development-Östersund Hospital, Region Jämtland Härjedalen, Östersund, Sweden
| | - K. Alverlind
- Unit of Research, Education and Development-Östersund Hospital, Region Jämtland Härjedalen, Östersund, Sweden
| | - E. Samuelsson
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
| | - T. Mooe
- Department of Public Health and Clinical Medicine, Umeå University, 90187 Umeå, Sweden
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Palmer CL, Rindal OMH. Wireless, Real-Time Plane-Wave Coherent Compounding on an iPhone: A Feasibility Study. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2019; 66:1222-1231. [PMID: 31056494 DOI: 10.1109/tuffc.2019.2914555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The processing power in commercially available hand-held devices has improved dramatically in recent years. In parallel, techniques used in high-frame-rate medical ultrasound imaging, especially plane-wave (PW) imaging, have reduced the number of ultrasound transmissions and amount of data necessary to reconstruct an ultrasound image. In combination, the processing power and data reduction allow all of the processing steps in ultrasound image formation, from raw ultrasound channel data to final rendering, to be performed on a hand-held device. In this study, we send the raw ultrasound channel data from a research scanner wirelessly to an off-the-shelf hand-held device. The hand-held unit's graphical processing unit is processing the raw ultrasound data into the final image, achieving real-time frame rates on the order of 60-90 frames per second (FPS) for a single-angle PW transmission. Higher quality images are achieved by trading off frame rate by coherently compounding multiple PW images, resulting in frame rates on the order of, e.g., 13 FPS when coherently compounding 7 PW transmissions. The presented setup has the potential of providing image quality which could be valuable for simple medical ultrasound diagnostic scans of, e.g., the carotid artery or thyroid. Also, since the computationally expensive beamforming can be done in off-the-shelf devices, this could reduce the price of hand-held ultrasound systems in the future.
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Seetharam K, Kagiyama N, Sengupta PP. Application of mobile health, telemedicine and artificial intelligence to echocardiography. Echo Res Pract 2019; 6:R41-R52. [PMID: 30844756 PMCID: PMC6432977 DOI: 10.1530/erp-18-0081] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Accepted: 02/20/2019] [Indexed: 01/20/2023] Open
Abstract
The intersection of global broadband technology and miniaturized high-capability computing devices has led to a revolution in the delivery of healthcare and the birth of telemedicine and mobile health (mHealth). Rapid advances in handheld imaging devices with other mHealth devices such as smartphone apps and wearable devices are making great strides in the field of cardiovascular imaging like never before. Although these technologies offer a bright promise in cardiovascular imaging, it is far from straightforward. The massive data influx from telemedicine and mHealth including cardiovascular imaging supersedes the existing capabilities of current healthcare system and statistical software. Artificial intelligence with machine learning is the one and only way to navigate through this complex maze of the data influx through various approaches. Deep learning techniques are further expanding their role by image recognition and automated measurements. Artificial intelligence provides limitless opportunity to rigorously analyze data. As we move forward, the futures of mHealth, telemedicine and artificial intelligence are increasingly becoming intertwined to give rise to precision medicine.
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Affiliation(s)
- Karthik Seetharam
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Nobuyuki Kagiyama
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
| | - Partho P Sengupta
- West Virginia University Heart and Vascular Institute, Morgantown, West Virginia, USA
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Gong FF, Campbell DJ, Prior DL. Noninvasive Cardiac Imaging and the Prediction of Heart Failure Progression in Preclinical Stage A/B Subjects. JACC Cardiovasc Imaging 2018; 10:1504-1519. [PMID: 29216977 DOI: 10.1016/j.jcmg.2017.11.001] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2016] [Revised: 10/25/2017] [Accepted: 11/01/2017] [Indexed: 12/16/2022]
Abstract
Heart failure (HF) continues to grow as a cause of morbidity and mortality in our community and presents a significant public health problem, predominantly in individuals ≥65 years of age. Early intervention in asymptomatic HF subjects (Stage A/B) at risk of progression to symptomatic HF (Stage C/D) may provide an opportunity to halt this epidemic. The ability of cardiac imaging to assess cardiac structure and function permits early identification of those at increased risk of developing symptomatic HF. Systolic, diastolic, and structural left ventricular parameters each predict symptomatic HF, but no single parameter has sufficient sensitivity for screening to identify individuals with Stage A/B HF who are at increased risk of disease progression. Transthoracic echocardiography (TTE) has the advantage over other imaging modalities in being able to measure systolic, diastolic, and structural left ventricular parameters, and it identified at least 1 abnormal parameter in >50% of individuals with Stage A/B HF ≥65 years of age. Moreover, identification of at least 1 abnormality according to TTE in individuals with Stage A/B HF ≥65 years of age had 72% to 82% sensitivity for detection of those who subsequently developed symptomatic HF. Therefore, a case can be made for cardiac imaging by using TTE for community-dwelling populations with Stage A/B HF ≥65 years of age to identify those with increased risk of symptomatic HF who can be offered preventative therapies. Further studies are required to determine the best strategy for identifying the risk of symptomatic HF in younger individuals.
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Affiliation(s)
- Fei Fei Gong
- Department of Medicine, University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Institute of Medical Research, Fitzroy, Australia
| | - Duncan J Campbell
- Department of Medicine, University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Australia; St. Vincent's Institute of Medical Research, Fitzroy, Australia
| | - David L Prior
- Department of Medicine, University of Melbourne, St. Vincent's Hospital Melbourne, Fitzroy, Australia; Department of Cardiology, St. Vincent's Hospital Melbourne, Fitzroy Australia.
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Di Ianni T, Villagomez Hoyos CA, Ewertsen C, Kjeldsen TK, Mosegaard J, Nielsen MB, Jensen JA. A Vector Flow Imaging Method for Portable Ultrasound Using Synthetic Aperture Sequential Beamforming. IEEE TRANSACTIONS ON ULTRASONICS, FERROELECTRICS, AND FREQUENCY CONTROL 2017; 64:1655-1665. [PMID: 28841555 DOI: 10.1109/tuffc.2017.2742599] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
This paper presents a vector flow imaging method for the integration of quantitative blood flow imaging in portable ultrasound systems. The method combines directional transverse oscillation (TO) and synthetic aperture sequential beamforming to yield continuous velocity estimation in the whole imaging region. Six focused emissions are used to create a high-resolution image (HRI), and a dual-stage beamforming approach is used to lower the data throughput between the probe and the processing unit. The transmit/receive focal points are laterally separated to obtain a TO in the HRI that allows for the velocity estimation along the lateral and axial directions using a phase-shift estimator. The performance of the method was investigated with constant flow measurements in a flow rig system using the SARUS scanner and a 4.1-MHz linear array. A sequence was designed with interleaved B-mode and flow emissions to obtain continuous data acquisition. A parametric study was carried out to evaluate the effect of critical parameters. The vessel was placed at depths from 20 to 40 mm, with beam-to-flow angles of 65°, 75°, and 90°. For the lateral velocities at 20 mm, a bias between -5% and -6.2% was obtained, and the standard deviation (SD) was between 6% and 9.6%. The axial bias was lower than 1% with an SD around 2%. The mean estimated angles were 66.70° ± 2.86°, 72.65° ± 2.48°, and 89.13° ± 0.79° for the three cases. A proof-of-concept demonstration of the real-time processing and wireless transmission was tested in a commercial tablet obtaining a frame rate of 27 frames/s and a data rate of 14 MB/s. An in vivo measurement of a common carotid artery of a healthy volunteer was finally performed to show the potential of the method in a realistic setting. The relative SD averaged over a cardiac cycle was 4.33%.
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Lo MH, Huang CF, Lin IC, Lin YJ, Kuo HC, Hsieh KS. Clinical utility and diagnostic accuracy of palm-held, mini-sized ultrasonocardiographic scanner in congenital heart disease. J Formos Med Assoc 2017; 117:141-146. [PMID: 28404481 DOI: 10.1016/j.jfma.2017.02.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 01/24/2017] [Accepted: 02/03/2017] [Indexed: 10/19/2022] Open
Abstract
BACKGROUND/PURPOSE To investigate whether a palm-held ultrasonocardiographic scanner would be useful for screening and follow-up in congenital heart disease (CHD). METHODS We retrospectively reviewed the echocardiographic images from June 1, 2014 to November 1, 2014. All patients underwent two ultrasonographic examinations including palm-held scanner examination and standard echocardiography. To compare the quality of the two instruments, we developed a diagnostic scoring system ranging from 1 point to 10 points, with 10 points indicating the best quality. Two experienced echocardiographers retrospectively reviewed all recorded images blindedly and gave each examination a score. Comparisons of diagnostic score between two equipments were performed. RESULTS A total of 262 patients' images were reviewed. All cardiac lesions could be detected with both instruments. The mean diagnostic score of palm-held scanner and standard echocardiography were 8.20±0.53 versus 9.64±0.37 (p<0.05) in color image and 7.00±1.05 versus 8.56±1.14 (p<0.05) in gray-scale two-dimensional image, respectively. When we compared the score between the two instruments in individual CHDs, we found standard echocardiography had better quality except for detecting muscular ventricular septal defect and pulmonary regurgitation. CONCLUSION The diagnostic sensitivity of palm-held scanner in detecting CHD was very good. Despite both instruments having a high diagnostic score in detecting CHD, standard echocardiography had better quality. Traditional echocardiography is still the standard tool for CHD evaluation. However, the palm-held scanner can support physical examination for initial screening and follow-up, and offer cardiologists an opportunity to visualize and listen to the heart at any time.
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Affiliation(s)
- Mao-Hung Lo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Chien-Fu Huang
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - I-Chun Lin
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Ying-Jui Lin
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Hsuan-Chang Kuo
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan
| | - Kai-Sheng Hsieh
- Department of Pediatrics, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, Taiwan.
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Ruddox V, Norum IB, Stokke TM, Edvardsen T, Otterstad JE. Focused cardiac ultrasound by unselected residents-the challenges. BMC Med Imaging 2017; 17:22. [PMID: 28259149 PMCID: PMC5336635 DOI: 10.1186/s12880-017-0191-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Accepted: 02/21/2017] [Indexed: 11/22/2022] Open
Abstract
Background 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. Methods 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. Results 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. Conclusions A FoCUS protocol with a 4-h training program gained clinical usefulness in one third of examinations. False positive findings represented the major challenge.
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Affiliation(s)
- Vidar Ruddox
- Department of cardiology, Vestfold Hospital Trust, Po. Box 2168, N3103, Tønsberg, Norway. .,Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
| | - Ingvild Billehaug Norum
- Department of cardiology, Vestfold Hospital Trust, Po. Box 2168, N3103, Tønsberg, Norway.,Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thomas Muri Stokke
- Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Thor Edvardsen
- Department of cardiology, Oslo University Hospital, Rikshospitalet, and University of Oslo, Oslo, Norway.,Center for Cardiological Innovation, Oslo University Hospital, Rikshospitalet, Oslo, Norway
| | - Jan Erik Otterstad
- Department of cardiology, Vestfold Hospital Trust, Po. Box 2168, N3103, Tønsberg, Norway
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Kobal SL, Liel-Cohen N, Shimony S, Neuman Y, Konstantino Y, Dray EM, Horowitz I, Siegel RJ. Impact of Point-of-Care Ultrasound Examination on Triage of Patients With Suspected Cardiac Disease. Am J Cardiol 2016; 118:1583-1587. [PMID: 27634025 DOI: 10.1016/j.amjcard.2016.08.028] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/21/2016] [Revised: 08/02/2016] [Accepted: 08/02/2016] [Indexed: 11/19/2022]
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.
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Affiliation(s)
- Sergio L Kobal
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Noah Liel-Cohen
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sarah Shimony
- Heart Institute, Kaplan Medical Center, Rehovot and Hadassah Medical School, The Hebrew University, Jerusalem, Israel
| | - Yoram Neuman
- Division of Cardiology, Meir Medical Center, Kfar-Saba and Sackler Faculty of Medicine, Tel Aviv University, Israel
| | - Yuval Konstantino
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Efrat Mazor Dray
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Itai Horowitz
- Division of Cardiology, Soroka University Medical Center and Joyce and Irving Goldman Medical School, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Robert J Siegel
- Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center and UCLA, Los Angeles, California.
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Marwick T, Narula J. Learning to Permit Disruptive Innovation…. J Am Soc Echocardiogr 2016; 29:998-999. [DOI: 10.1016/j.echo.2016.08.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Woo JSL, Magotti R, Benzie R. A futuristic vision of pocket ultrasound machines: watch this space. Australas J Ultrasound Med 2015; 17:110-112. [PMID: 28191219 PMCID: PMC5024944 DOI: 10.1002/j.2205-0140.2014.tb00025.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022] Open
Abstract
Introduction: Australian medical ultrasound started in 1959 with the establishment of the Ultrasonics Institute. Since then the technology has advanced tremendously. We are now not only able to obtain clearer images on high specification ultrasound machines but also on pocket‐sized ultrasound machines that are compact, lightweight and affordable. Method: The following descriptive review will examine the indication for use of pocket ultrasound machines in different clinical settings as well as provide evidence of its image clarity and accuracy. Potentially eligible studies were sought primarily through searches of the electronic databases PubMed, Medline (1996–Present), Embase (1996–Present) and Cochrane Library. Conclusion: Pocket ultrasound machines, with appropriate ultrasound knowledge and training, can be incorporated successfully in patient management. The addition of point‐of‐care ultrasound has been shown to improve management recommendations and outcomes.
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Affiliation(s)
- Joyce Su Ling Woo
- Christopher Kohlenberg Department of Perinatal Ultrasound Nepean Hospital Penrith New South Wales Australia
| | - Robert Magotti
- Christopher Kohlenberg Department of Perinatal UltrasoundNepean HospitalPenrithNew South WalesAustralia; Sydney Medical School NepeanUniversity of SydneyNepean HospitalPenrithNew South WalesAustralia
| | - Ronald Benzie
- Christopher Kohlenberg Department of Perinatal UltrasoundNepean HospitalPenrithNew South WalesAustralia; Sydney Medical School NepeanUniversity of SydneyNepean HospitalPenrithNew South WalesAustralia
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Nakanishi K, Fukuda S, Yamashita H, Uetsuhara T, Sakamoto A, Yamasaki K, Kosaka M, Shirai N, Uono H, Yoshikawa J, Otsuji Y, Shimada K. Detection of Deep Venous Thrombosis Using a Pocket-Size Ultrasound Examination Device. JACC Cardiovasc Imaging 2015; 9:897-898. [PMID: 26363831 DOI: 10.1016/j.jcmg.2015.06.012] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 06/04/2015] [Accepted: 06/04/2015] [Indexed: 10/23/2022]
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Lau L, Ducas R, Rizkallah J, Jassal DS, Seifer CM. The utility of pocket-sized echocardiography to assess left ventricular systolic function prior to permanent pacemaker implantation. Cardiovasc Ultrasound 2015; 13:10. [PMID: 25888874 PMCID: PMC4369064 DOI: 10.1186/s12947-015-0004-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/17/2014] [Accepted: 02/19/2015] [Indexed: 11/23/2022] Open
Abstract
Background A subset of patients receiving first-time permanent pacemakers (PPM) may also benefit from an implantable cardioverter defibrillator (ICD) based on the presence of left ventricular systolic dysfunction (LVSD). Routine screening using pocket-sized echocardiography (PSE) may be useful in identifying such patients. Objective To determine whether PSE can be used by an inexperienced sonographer to adequately screen for LVSD in a patient population receiving a first-time PPM. Methods A sonographic trainee (medical student) acquired images using PSE, which were then evaluated by an experienced echocardiologist for both image quality and presence of LVSD. The sensitivity and specificity of assessment by the inexperienced sonographer was compared to the level 3 echocardiologist. Results The patient population included 71 individuals (66% male, mean age 77 ± 12 years). Interpretable images where left ventricular ejection fraction (LVEF) could be adequately assessed were obtained in 93% of the patient population. As compared with the echocardiologist, the sonographic trainee had a sensitivity of 60% and a specificity of 98% in detecting LVSD. Conclusions For patients receiving first-time PPM, the use of PSE by a sonographic trainee combined with interpretation by an experienced imaging cardiologist can triage for the need to perform standard transthoracic echocardiography (sTTE) by determining the presence of LVSD.
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Affiliation(s)
- Lawrence Lau
- College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. .,Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Robin Ducas
- College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. .,Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Jacques Rizkallah
- College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. .,Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Davinder S Jassal
- College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. .,Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada.
| | - Colette M Seifer
- College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. .,Section of Cardiology, Department of Internal Medicine, College of Medicine, Faculty of Health Sciences, University of Manitoba, Winnipeg, Canada. .,Section of Cardiology, Department of Internal Medicine and Associate Chief of Cardiology, Cardiac Sciences Program, Y3019 St Boniface Hospital, Winnipeg, MB, UK.
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15
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Mirabel M, Celermajer D, Beraud AS, Jouven X, Marijon E, Hagège AA. Pocket-sized focused cardiac ultrasound: strengths and limitations. Arch Cardiovasc Dis 2015; 108:197-205. [PMID: 25747662 DOI: 10.1016/j.acvd.2015.01.002] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Revised: 01/09/2015] [Accepted: 01/13/2015] [Indexed: 10/23/2022]
Abstract
Focused cardiac ultrasound (FCU) has emerged in recent years and has created new possibilities in the clinical assessment of patients both in and out of hospital. The increasing portability of echocardiographic devices, with some now only the size of a smartphone, has widened the spectrum of potential indications and users, from the senior cardiologist to the medical student. However, many issues still need to be addressed, especially the acknowledgment of the advantages and limitations of using such devices for FCU, and the extent of training required in this rapidly evolving field. In recent years, an increasing number of studies involving FCU have been published with variable results. This review outlines the evidence for the use of FCU with pocket-echo to address specific questions in daily clinical practice.
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Affiliation(s)
- Mariana Mirabel
- Assistance publique-Hôpitaux de Paris, hôpital Européen-Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Inserm U970, Paris Cardiovascular Research Centre-PARCC, 75737 Paris Cedex 15, France.
| | | | - Anne-Sophie Beraud
- Stanford University Hospital, Stanford, CA, USA; Clinique Pasteur, 31300 Toulouse, France
| | - Xavier Jouven
- Assistance publique-Hôpitaux de Paris, hôpital Européen-Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Inserm U970, Paris Cardiovascular Research Centre-PARCC, 75737 Paris Cedex 15, France
| | - Eloi Marijon
- Assistance publique-Hôpitaux de Paris, hôpital Européen-Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Inserm U970, Paris Cardiovascular Research Centre-PARCC, 75737 Paris Cedex 15, France
| | - Albert A Hagège
- Assistance publique-Hôpitaux de Paris, hôpital Européen-Georges-Pompidou, 75015 Paris, France; Université Paris Descartes, Sorbonne Paris Cité, 75006 Paris, France; Inserm U970, Paris Cardiovascular Research Centre-PARCC, 75737 Paris Cedex 15, France
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Fukuda S, Watanabe H, Iwakura K, Daimon M, Ito H, Yoshikawa J. Multicenter Investigations of the Prevalence of Abdominal Aortic Aneurysm in Elderly Japanese Patients With Hypertension. Circ J 2015; 79:524-9. [DOI: 10.1253/circj.cj-14-0972] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Shota Fukuda
- Department of Medicine, Osaka Ekisaikai Hospital
| | | | | | - Masao Daimon
- Clinical Laboratory, The University of Tokyo Hospital
| | - Hiroshi Ito
- Department of Cardiovascular Medicine, Okayama University Graduate School of Medicine and Dentistry
| | - Junichi Yoshikawa
- Department of Cardiology, Nishinomiya Watanabe Cardiovascular Center
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Abstract
The optimum management of acute medical patients requires prompt and accurate diagnosis, monitoring and treatment. The clinical history and physical examination remain central to diagnosis, but often need supplementation by laboratory testing or imaging. Echocardiographic assessment of cardiac structure and function provides valuable information that can aid diagnosis and assess clinical progress. It has many advantages as an imaging modality, and recent technological advances have resulted in hand-held, battery-powered ultrasound devices that provide high-quality images. Three broad applications of cardiac ultrasound now exist: conventional echocardiography, focussed echocardiography and the quick-scan. A quick-scan using a hand-held ultrasound device is readily integrated into the bedside clinical assessment, providing information that can be used immediately in diagnostic reasoning; it can also guide pericardiocentesis. Hand-held ultrasound devices can also be used in acute situations, as well as geographically remote areas or special situations (eg disaster zones) where other imaging is not available. However, the diagnostic yield of echocardiography is user dependent, and training is required for its benefits to be realised, adding to the hardware costs. More data are needed on the incremental value of hand-held ultrasonography and a quick-scan over conventional methods of assessment, their impact on clinical outcomes, and cost effectiveness.
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Affiliation(s)
- Sandeep S Hothi
- Murray Edwards College, University of Cambridge, Cambridge, UK, and clinical lecturer in cardiology, Glenfield Hospital, Leicester, UK
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18
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Evensen K, Dahl A, Ronning OM, Russell D. The Assessment of Carotid Atherosclerosis Using a New Multipurpose Ultrasound Probe. J Neuroimaging 2014; 25:232-237. [DOI: 10.1111/jon.12105] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2013] [Revised: 09/23/2013] [Accepted: 10/02/2013] [Indexed: 11/30/2022] Open
Affiliation(s)
- Kristin Evensen
- Department of Neurology; Oslo University Hospital Rikshospitalet; Nydalen Oslo Norway
| | - Arve Dahl
- Department of Neurology; Oslo University Hospital Rikshospitalet; Nydalen Oslo Norway
| | - Ole M. Ronning
- Department of Neurology; Medical Division; Akershus University Hospital; Lorenskog. Faculty of Medicine; University of Oslo; Oslo Norway
| | - David Russell
- Department of Neurology; Oslo University Hospital Rikshospitalet; Nydalen Oslo Norway
- Faculty of Medicine; University of Oslo; Oslo Norway
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Dalen H, Haugen BO, Graven T. Feasibility and clinical implementation of hand-held echocardiography. Expert Rev Cardiovasc Ther 2014; 11:49-54. [DOI: 10.1586/erc.12.165] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Kitada R, Fukuda S, Watanabe H, Oe H, Abe Y, Yoshiyama M, Song JM, Sitges M, Shiota T, Ito H, Yoshikawa J. Diagnostic accuracy and cost-effectiveness of a pocket-sized transthoracic echocardiographic imaging device. Clin Cardiol 2013; 36:603-10. [PMID: 23893844 DOI: 10.1002/clc.22171] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Revised: 06/05/2013] [Indexed: 11/07/2022] Open
Abstract
BACKGROUND The recently introduced pocket-sized portable transthoracic echocardiography (pTTE) is accurate for measurement of cardiac chamber size and function as well as for assessment of valvular regurgitation. This study aimed to compare the diagnostic accuracy of the pocket-sized pTTE with the standard TTE (sTTE) and assess its cost-effectiveness. HYPOTHESIS The use of pocket-sized pTTE, as an initial screening tool, may be feasible, accurate and cost-effective in the diagnostic strategy of cardiac abnormalities. METHODS The study subjects were 200 patients scheduled for sTTE and an electrocardiogram (ECG). Each patient underwent pTTE examination with the Vscan (GE Medical Systems, Milwaukee, WI) immediately after sTTE. The findings of pTTE and the ECG were compared with the results of sTTE. Cost-effectiveness was calculated. RESULTS There was a strong agreement in the detection of abnormal findings between pTTE and sTTE (agreement = 90%), whereas the agreement between the ECG and sTTE was 65%. When pTTE or the ECG was used as an initial screening tool prior to sTTE, similar cost reduction was obtained (approximately 30%) by reducing the number of referrals for sTTE. However, the negative predictive value of a diagnostic strategy with pTTE (92%) was superior to that with an ECG (67%). CONCLUSIONS This study demonstrates that the pocket-sized pTTE provides accurate detection of cardiac structural and functional abnormalities beyond the ECG. In addition, the use of pTTE as an initial screening tool prior to sTTE is cost-effective, suggesting that the pocket-sized pTTE is poised to alter the current diagnostic strategy in clinical practice.
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Affiliation(s)
- Ryoko Kitada
- Department of Internal Medicine and Cardiology (Kitada), Osaka City University School of Medicine, Osaka, Japan
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Ability of a new pocket echoscopic device to detect abdominal and pleural effusion in blunt trauma patients. Am J Emerg Med 2013; 31:437-9. [PMID: 23407034 DOI: 10.1016/j.ajem.2012.11.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2012] [Revised: 11/12/2012] [Accepted: 11/13/2012] [Indexed: 11/22/2022] Open
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Singh S, Bansal M, Maheshwari P, Adams D, Sengupta SP, Price R, Dantin L, Smith M, Kasliwal RR, Pellikka PA, Thomas JD, Narula J, Sengupta PP. American Society of Echocardiography: Remote Echocardiography with Web-Based Assessments for Referrals at a Distance (ASE-REWARD) Study. J Am Soc Echocardiogr 2013; 26:221-33. [DOI: 10.1016/j.echo.2012.12.012] [Citation(s) in RCA: 83] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2012] [Indexed: 11/28/2022]
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Biais M, Carrié C, Delaunay F, Morel N, Revel P, Janvier G. Evaluation of a new pocket echoscopic device for focused cardiac ultrasonography in an emergency setting. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2012; 16:R82. [PMID: 22583539 PMCID: PMC3580625 DOI: 10.1186/cc11340] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/04/2012] [Accepted: 05/14/2012] [Indexed: 11/14/2022]
Abstract
Introduction In the emergency setting, focused cardiac ultrasound has become a fundamental tool for diagnostic, initial emergency treatment and triage decisions. A new ultra-miniaturized pocket ultrasound device (PUD) may be suited to this specific setting. Therefore, we aimed to compare the diagnostic ability of an ultra-miniaturized ultrasound device (Vscan™, GE Healthcare, Wauwatosa, WI) and of a conventional high-quality echocardiography system (Vivid S5™, GE Healthcare) for a cardiac focused ultrasonography in patients admitted to the emergency department. Methods During 4 months, patients admitted to our emergency department and requiring transthoracic echocardiography (TTE) were included in this single-center, prospective and observational study. Patients underwent TTE using a PUD and a conventional echocardiography system. Each examination was performed independently by a physician experienced in echocardiography, unaware of the results found by the alternative device. During the focused cardiac echocardiography, the following parameters were assessed: global cardiac systolic function, identification of ventricular enlargement or hypertrophy, assessment for pericardial effusion and estimation of the size and the respiratory changes of the inferior vena cava (IVC) diameter. Results One hundred fifty-one (151) patients were analyzed. With the tested PUD, the image quality was sufficient to perform focused cardiac ultrasonography in all patients. Examination using PUD adequately qualified with a very good agreement global left ventricular systolic dysfunction (κ = 0.87; 95%CI: 0.76-0.97), severe right ventricular dilation (κ = 0.87; 95%CI: 0.71-1.00), inferior vena cava dilation (κ = 0.90; 95%CI: 0.80-1.00), respiratory-induced variations in inferior vena cava size in spontaneous breathing (κ = 0.84; 95%CI: 0.71-0.98), pericardial effusion (κ = 0.75; 95%CI: 0.55-0.95) and compressive pericardial effusion (κ = 1.00; 95%CI: 1.00-1.00). Conclusions In an emergency setting, this new ultraportable echoscope (PUD) was reliable for the real-time detection of focused cardiac abnormalities.
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Intérêt de l’échographie pulmonaire dans les insuffisances respiratoires aiguës en préhospitalier. ANNALES FRANCAISES DE MEDECINE D URGENCE 2012. [DOI: 10.1007/s13341-012-0191-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Mjolstad OC, Dalen H, Graven T, Kleinau JO, Salvesen O, Haugen BO. Routinely adding ultrasound examinations by pocket-sized ultrasound devices improves inpatient diagnostics in a medical department. Eur J Intern Med 2012; 23:185-91. [PMID: 22284252 DOI: 10.1016/j.ejim.2011.10.009] [Citation(s) in RCA: 81] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2011] [Revised: 10/06/2011] [Accepted: 10/13/2011] [Indexed: 11/27/2022]
Abstract
BACKGROUND We aimed to investigate the potential benefit of adding a routine cardiac and abdominal diagnostic examination by pocket-sized ultrasound device in patients admitted to a medical department. METHODS A random sample of 196 patients admitted to the medical department at a non-university hospital in Norway between March and September 2010 was studied. The patients underwent cardiac and abdominal screening with a pocket-sized ultrasound device with B-mode and color flow imaging after a principal diagnosis was set. Three internists/cardiologists experienced in ultrasonography performed the examinations. Diagnostic corrections were made and findings were confirmed by high-end echocardiography and examinations at the radiologic department. RESULTS 196 patients were included (male=56.6%, mean±SD; 68.1±15.0 years old). The time spent doing the ultrasound screening was mean±SD 4.3±1.6 min for the cardiac screening and 2.5±1.1 min for the abdominal screening. In 36 (18.4%) patients this examination resulted in a major change in the primary diagnosis. In 38 (19.4%) patients the diagnosis was verified and in 18 (9.2%) patients an important additional diagnosis was made. CONCLUSION By adding a pocket-sized ultrasound examination of <10 min to usual care, we corrected the diagnosis in almost 1 of 5 patients admitted to a medical department, resulting in a completely different treatment strategy without delay in many of the patients. Routinely adding a cardiac and abdominal ultrasound screening has the potential to rearrange inpatients workflow and diagnosis.
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Affiliation(s)
- Ole Christian Mjolstad
- MI Lab and Department of Circulation and Medical Imaging, Norwegian University of Science and Technology, Postboks 8905, 7491 Trondheim, Norway.
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