Department of Cardiology, Aarhus University Hospital, Skejby, Denmark.
Scand J Trauma Resusc Emerg Med. 2013 Dec 13;21:87. doi: 10.1186/1757-7241-21-87.
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.
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.
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).
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.
本研究旨在比较在心脏病学专家对心血管超声检查具有专家技能的情况下，新手检查者在床边进行即时心脏超声检查的诊断准确性，以评估心内科或心胸外科病房患者的六种临床相关心脏情况。
由新手检查者在床边进行心脏超声检查，并在即时护理环境下对图像进行解释，结果为二分类（是/否）。定义了六个结果类别：1）心包积液（≥10mm），2）左心室扩张（≥62mm），3）右心室扩张（≥42mm或≥左心室直径），4）左心室肥厚（≥13mm），5）左心室衰竭（EF≤40%），6）主动脉瓣狭窄（最大流速≥3m/s）。检查者对患者的病史和以前的超声心动图检查结果均不知情。解释即时护理超声检查结果与心脏病学专家进行的超声心动图诊断进行比较。
共纳入 102 例内科和外科患者。共评估了 612 项，分 6 个类别进行评估。新手检查者和专家的评估结果有 95.6%是一致的；总体敏感性为 0.91，特异性为 0.97。阳性预测值为 0.92，阴性预测值为 0.97。观察者之间的 Kappa 统计显示出良好的一致性（κ=0.88）。
本研究表明，新手检查者使用即时超声检查能够在六个不同类别中准确检测常见且重要的心脏病理。
