Mai Tuan V, Ahn David T, Phillips Colin T, Agan Donna L, Kimura Bruce J
Department of Graduate Medical Education, Scripps Mercy Hospital, 4077 Fifth Avenue, MER-35, San Diego, CA 92103, USA.
Emerg Med Int. 2013;2013:627230. doi: 10.1155/2013/627230. Epub 2013 Aug 20.
Background. The potential of pocket-sized ultrasound devices (PUDs) to improve global healthcare delivery is limited by the lack of a suitable imaging protocol and trained users. Therefore, we investigated the feasibility of performing a brief, evidence-based cardiac limited ultrasound exam (CLUE) through wireless guidance of novice users. Methods. Three trainees applied PUDs on 27 subjects while directed by an off-site cardiologist to obtain a CLUE to screen for LV systolic dysfunction (LVSD), LA enlargement (LAE), ultrasound lung comets (ULC+), and elevated CVP (eCVP). Real-time remote audiovisual guidance and interpretation by the cardiologist were performed using the iPhone 4/iPod (FaceTime, Apple, Inc.) attached to the PUD and transmitted data wirelessly. Accuracy and technical quality of transmitted images were compared to on-site, gold-standard echo thresholds. Results. Novice versus sonographer imaging yielded technically adequate views in 122/135 (90%) versus 130/135 (96%) (P < 0.05). CLUE's combined SN, SP, and ACC were 0.67, 0.96, and 0.90. Technical adequacy (%) and accuracy for each abnormality (n) were LVSD (85%, 0.93, n = 5), LAE (89%, 0.74, n = 16), ULC+ (100%, 0.94, n = 5), and eCVP (78%, 0.91, n = 1). Conclusion. A novice can perform the CLUE using PUD when wirelessly guided by an expert. This method could facilitate PUD use for off-site bedside medical decision making and triaging of patients.
背景。袖珍超声设备（PUDs）改善全球医疗服务的潜力因缺乏合适的成像方案和经过培训的使用者而受到限制。因此，我们研究了通过新手使用者的无线引导进行简短的、基于证据的心脏有限超声检查（CLUE）的可行性。方法。三名受训人员在远程心脏病专家的指导下，对27名受试者使用PUDs，以获取CLUE，用于筛查左心室收缩功能障碍（LVSD）、左心房扩大（LAE）、超声肺彗星征（ULC+）和中心静脉压升高（eCVP）。心脏病专家使用连接到PUD的iPhone 4/iPod（FaceTime，苹果公司）进行实时远程视听指导和解读，并无线传输数据。将传输图像的准确性和技术质量与现场的金标准超声阈值进行比较。结果。新手与超声检查人员成像在122/135（90%）与130/135（96%）中产生技术上足够的图像（P<0.05）。CLUE的综合敏感度（SN）、特异度（SP）和准确率（ACC）分别为0.67、0.96和0.90。每种异常情况（n）的技术充足率（%）和准确率分别为LVSD（85%，0.93，n = 5）、LAE（89%，0.74，n = 16）、ULC+（100%，0.94，n = 5）和eCVP（78%，0.91，n = 1）。结论。新手在专家的无线引导下可以使用PUD进行CLUE检查。这种方法可以促进PUD用于远程床边医疗决策和患者分诊。
