Assessment of cardiac pathology by point-of-care ultrasonography performed by a novice
examiner is comparable to the gold standard
Sammanfattning
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 (?=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.