Haji-Hassan Mariam, Duțu Bogdan, Bolboacă Sorana D
Department of Medical Informatics and Biostatistics, "Iuliu Hațieganu" University of Medicine and Pharmacy Cluj-Napoca, Louis Pasteur Str., No. 6, 400349 Cluj-Napoca, Romania.
Cardiology Section, Clinical Rehabilitation Hospital, Viilor Str., No. 46-50, 400437 Cluj-Napoca, Romania.
Diagnostics (Basel). 2023 Feb 23;13(5):853. doi: 10.3390/diagnostics13050853.
The professional association has already developed guidelines on the appropriate use of handheld ultrasound devices, especially in an emergency setting. Handheld ultrasound devices are seen as the 'stethoscope of the future' to assist in physical examination. Our exploratory study evaluated whether the measurements of cardiovascular structures and the agreement in identifying aortic, mitral, and tricuspid valve pathology made by a resident with a handheld device (HH, Kosmos Torso-One) reach the results reported by an experienced examiner who used a high-end device (STD). Patients referred for cardiology examination in a single center from June to August 2022 were eligible for the study. Patients who agreed to participate underwent two heart ultrasound examinations scanned by the same two operators. A cardiology resident performed the first examination with a HH ultrasound device, and an experienced examiner performed the second examination with an STD device. Forty-three consecutive patients were eligible, and forty-two were included in the study. One obese patient was excluded because none of the examiners succeeded in performing the heart examination. The measurements obtained with HH were generally higher than those obtained with STD, with the highest mean difference of 0.4 mm, but without significant differences (all 95% confidence intervals of the differences contain the value of 0). For valvular disease, the lowest agreement was observed for mitral valve regurgitation (26/42, with a Kappa concordance coefficient of 0.5321), which was missed in almost half of the patients with mild regurgitation and underestimated in half of the patients with moderate mitral regurgitation. The measurements performed by the resident with the handheld Kosmos Torso-One device showed high concordance with those conducted by the experienced examiner with a larger high-end ultrasound device. The learning curve of the resident could explain the limited performance in identifying valvular pathologies between examiners.
该专业协会已经制定了关于手持超声设备合理使用的指南，尤其是在紧急情况下。手持超声设备被视为辅助体格检查的“未来听诊器”。我们的探索性研究评估了住院医师使用手持设备（HH，Kosmos Torso-One）测量心血管结构以及识别主动脉、二尖瓣和三尖瓣病变的一致性，是否能达到使用高端设备（STD）的经验丰富的检查者所报告的结果。2022年6月至8月在单一中心被转诊进行心脏科检查的患者符合该研究条件。同意参与的患者接受了由同两名操作人员进行的两次心脏超声检查。一名心脏科住院医师使用HH超声设备进行第一次检查，一名经验丰富的检查者使用STD设备进行第二次检查。连续43名患者符合条件，42名患者被纳入研究。一名肥胖患者被排除，因为没有检查者成功进行心脏检查。使用HH获得的测量值通常高于使用STD获得的测量值，最大平均差异为0.4毫米，但无显著差异（所有差异的95%置信区间都包含0值）。对于瓣膜疾病，二尖瓣反流的一致性最低（26/42，Kappa一致性系数为0.5321），几乎一半轻度反流患者漏诊，一半中度二尖瓣反流患者被低估。住院医师使用手持Kosmos Torso-One设备进行的测量与经验丰富的检查者使用更大的高端超声设备进行的测量显示出高度一致性。住院医师的学习曲线可以解释检查者之间在识别瓣膜病变方面表现有限的原因。
