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Comparative Study
. 2013 Dec 13:21:87.
doi: 10.1186/1757-7241-21-87.

Assessment of cardiac pathology by point-of-care ultrasonography performed by a novice examiner is comparable to the gold standard

Christian Alcaraz Frederiksen  1 , Peter Juhl-Olsen, Niels Holmark Andersen, Erik Sloth
Affiliations
Comparative Study

Assessment of cardiac pathology by point-of-care ultrasonography performed by a novice examiner is comparable to the gold standard

Christian Alcaraz Frederiksen et al. Scand J Trauma Resusc Emerg Med. .

Abstract

Background: The aim of the study was to compare the diagnostic accuracy of point-of-care cardiac ultrasonography performed by a novice examiner against results from a specialist in cardiology with expert skills in echocardiography, with regard to the assessment of six clinically relevant cardiac conditions in a population of ward patients from the Department of Cardiology or the Department of Cardiothoracic Surgery.

Methods: Cardiac ultrasonography was performed by a novice examiner at the bedside and images were interpreted in a point-of-care context with dichotomous outcomes (yes/no). Six outcome categories were defined: 1) pericardial effusion (≥10 mm), 2) left ventricular dilatation (≥62 mm), 3) right ventricular dilatation (≥42 mm or ≥ left ventricular diameter), 4) left ventricular hypertrophy (≥13 mm), 5) left ventricular failure (EF ≤ 40%), 6) aortic stenosis (maximum flow velocity ≥3 m/s). The examiner was blinded to the patients' medical history and results from previous echocardiographic examinations. Results from the interpreted point-of-care ultrasonography examination were compared with echocardiographic diagnosis made by a specialist in cardiology.

Results: A total of 102 medical and surgical patients were included. Assessments were made in six categories totalling 612 assessments. There was agreement between the novice examiner and the specialist in 95.6% of the cases; overall sensitivity was 0.91 and specificity was 0.97. Positive predictive value was 0.92 and negative predictive value was 0.97. Kappa statistics showed good agreement between observers (κ=0.88).

Conclusions: This study showed that a novice examiner was able to detect common and significant heart pathology in six different categories with good accuracy using POC ultrasonography.

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Figures

Figure 1
Figure 1
Schematic overview of the selection process of included patients.
Figure 2
Figure 2
Examples of severe pathology detected by POC ultrasonography at the bedside. Images were obtained by the novice examiner. Upper left panel: Pericaldial exudates. Upper right panel: Left ventricular dilation. Middle left panel: Right ventricular dilation. Middle right: Myocardial hypertrophy. Lower left: Impaired ejection fraction. Lower right: Aortic stenosis.
See this image and copyright information in PMC

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