Pocket-size echocardiograph - a valuable tool for non-experts or just a portable device for echocardiographers?

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ABSTRACT

Purpose

The diagnostic value of examinations performed with the use of pocket-size echocardiograph by medical professionals with different levels of experience remains to be determined. The aim of this study was to assess the diagnostic value of bedside echocardiographic examinations performed with the use of pocket-size echocardiograph by experienced cardiologist and medical students.

Material/Methods

The study group comprised 90 patients (63 men, 27 women; mean age 64±14 years) admitted to the cardiac intensive care unit and 30 patients from an out-patient clinic (21 men, 9 women; mean age 62±17 years). All patients underwent bedside echocardiographic examination performed with pocket-size echocardiograph by two briefly trained medical students (n= 90 patients) or cardiologist (n=30 patients). Major findings were recorded using a simplified questionnaire. Within 24 hours standard echocardiographic examination was performed in all patients by another cardiologist using a full sized echocardiograph.

The study group was divided into 4 subgroups: A / B – first / second half of in-patients examined by students, group C – in-patients examined by cardiologist, group D- out-patients examined by students.

Results

The agreement between standard transthoracic echocardiography (sTTE) and major findings on bedside transthoracic echocardiography (bTTE) was fair to moderate (kappa 0.293–0.57) in group A, moderate to very good (kappa 0.535–1.00) in group B, good to very good (kappa 0.734–1.00) in group C and moderate to very good (kappa 0.590–1.00) in group D.

Conclusions

Pocket-size echocardiograph enables an expert echocardiographer to perform reliable bedside examinations. When used by briefly trained medical students it provides an acceptable diagnostic value with notable learning curve effect.

Section snippets

INTRODUCTION

Echocardiographic examination is universally accepted as a non-invasive, side-effect-free procedure, providing a “visual supplement” to physical examination, enabling quick and thorough assessment of patient's cardiovascular status. Moreover, in emergency situations it enables immediate bedside evaluation of patients' status. However, conventional high-end systems, even though designed as mobile, in reality prove difficult to transport. The necessity for bedside examination, results in a

Study population

The study group consisted of 90 unselected patients (63 men, 27 women; mean age: 64±14 years) admitted or referred to the cardiac intensive care unit and 30 patients from an outpatient clinic referred for scheduled echocardiographic examination (21 men, 9 women; mean age: 62±17 years) by their treating doctor. Main reasons for mentioned referral were hypertension, stable angina, suspected valve disease, monitoring of patients suffering from chronic heart failure, heart function assessment prior

Duration of bTTE and quality of images

Mean time of bTTE in groups A, B, C and D was 6.3±1.5 minutes, 5.4±1.1 minutes, 2.8±1.2 minutes and 4.7±1.1 minutes, respectively (all differences observed between groups were statistically significant).

The quality of images in groups A and B were described as acceptable in 39 (65%) patients, good in 20 (33.3%) patients, whereas 1 (1.7%) patient (from group A) was excluded from analysis due to student's inability to acquire images of sufficient quality. In group D, acceptable and good quality

DISCUSSION

Our study is one of the first to present results concerning application of a pocket-size echocardiograph by novice echocardiographers after completion of a brief training program. [4, 5] The main finding is that pocket-size echocardiograph enables them to detect major abnormalities with an acceptable diagnostic value, which increases with the number of performed examinations. When used by an experienced sonographer the pocket echocardiograph allows for reliable basic bedside examinations.

The

CONCLUSIONS

Pocket-size echocardiograph enables an expert echocardiographer to perform reliable basic bedside examinations. When used by briefly trained medical student, it provides an acceptable diagnostic value regarding the detection of basic structural and functional findings with notable learning curve effect. Further studies are required to address the issue of training of non-experts in echocardiographic examinations with pocket-size systems.

ACKNOWLEDGEMENTS

The results of this study were presented at ESC Congress 2010 (European Society of Cardiology Congress, 28 Aug 2010 - 01 Sep 2010, Stockholm – Sweden).

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