Abstract 15275: The New Cardiac Bedside Assessment: Integrating Hand-Held Cardiac Ultrasound into the Evaluation of Cardiac Patients
Background: As hand held cardiac ultrasound (HHCU) gains widespread use, so grows interest in evaluation of performance and training requirements for non-cardiologists. Our objective was to characterize the experience of senior medicine residents (SIMRs) trained to conduct focused HHCU examinations integrated into the bedside assessment of undifferentiated patients.
Methods: Eight SIMRs completed an HHCU training program consisting of 4 hours of online modules, 4 hours of scanning, and 2 hours of cases. Training focused on the evaluation of aortic stenosis, mitral regurgitation, left ventricular (LV) systolic dysfunction, LV hypertrophy and pericardial effusions. Following training, SIMRs assessed undifferentiated patients with a routine history and physical examination and then conducted the HHCU protocol. The sensitivity and specificity of the routine bedside assessment (without HHCU) and the integrated bedside assessment with HHCU was determined for each lesion type, compared to formal transthoracic echocardiography (TTE) as a gold standard. SIMRs reported their confidence in their assessments and changes in management.
Results: Fifty assessments were studied. Reason for referral included dyspnea in 44% of patients, syncope/arrhythmia in 26% and chest pain in 20%. Mean age of patients assessed was 68 years and 54% were male. Median scan time for each assessment was 7 minutes. SIMRs reported that integration of HHCU altered their management plan in 36% of cases. TTE assessments were performed on 37 patients. SIMRs reported that HHCU improved confidence in identifying all lesions. Sensitivities and specificities are reported in the table.
Conclusions: Addition of HHCU to the bedside cardiac assessment improved sensitivity for several lesions at the expense of modest decreases in specificity. HHCU increased SIMR confidence in the assessment and management of patients with a short increase in the length of clinical encounters.
Author Disclosures: W. McIntyre: None. J.A. Gilmour: None. A. Baranchuk: None. P. Ewart: None. A.J. Sanfilippo: None. W.M. Hopman: None. J.W. Tam: None. A.M. Johri: None.
- © 2014 by American Heart Association, Inc.