Journal article
Handheld ultrasound versus physical examination in patients referred for transthoracic echocardiography for a suspected cardiac condition
JACC. Cardiovascular imaging, Vol.7(10), pp.983-990
10/01/2014
DOI: 10.1016/j.jcmg.2014.05.011
PMID: 25240450
Abstract
The purpose of this study was to test the hypothesis that handheld ultrasound (HHU) provides a more accurate diagnosis than physical examination in patients with suspected cardiovascular abnormalities and that its use thus reduces additional testing and overall costs.
Despite the limitations of physical examination and the demonstrated superiority of HHU for detecting cardiac abnormalities, it is not routinely used for the bedside diagnosis of cardiac conditions.
Patients referred for a standard echocardiogram for common indications (cardiac function, murmur, stroke, arrhythmias, and miscellaneous) underwent physical examination and HHU by different cardiologists, who filled out a form that also included suggestions for additional testing, if necessary, based on their findings.
Of 250 patients, 142 had an abnormal finding on standard echocardiogram. Of these, HHU correctly identified 117 patients (82%), and physical examination correctly identified 67 (47%, p < 0.0001). HHU was superior to physical examination (p < 0.0001) for both normal and abnormal cardiac function. It was also superior to physical examination in correctly identifying the presence of substantial valve disease (71% vs. 31%, p = 0.0003) and in identifying miscellaneous findings (47% vs. 3%, p < 0.0001). Of 108 patients without any abnormalities on standard echocardiography, further testing was suggested for 89 (82%) undergoing physical examination versus only 60 (56%) undergoing HHU (p < 0.0001). Cost modeling showed that HHU had an average cost of $644.43 versus an average cost of $707.44 for physical examination. This yielded a savings of $63.01 per patient when HHU was used versus physical examination.
When used by cardiologists, HHU provides a more accurate diagnosis than physical examination for the majority of common cardiovascular abnormalities. The finding of no significant abnormality on HHU is also likely to result in less downstream testing and thus potentially reduce the overall cost for patients being evaluated for a cardiovascular diagnosis.
Details
- Title: Subtitle
- Handheld ultrasound versus physical examination in patients referred for transthoracic echocardiography for a suspected cardiac condition
- Creators
- Manish Mehta - Oregon Health & Science UniversityTimothy Jacobson - Oregon Health & Science UniversityDawn Peters - Oregon Health & Science UniversityElizabeth Le - Oregon Health & Science UniversityScott Chadderdon - Oregon Health & Science UniversityAllison J Allen - Oregon Health & Science UniversityAaron B Caughey - Oregon Health & Science UniversitySanjiv Kaul - Oregon Health & Science University
- Resource Type
- Journal article
- Publication Details
- JACC. Cardiovascular imaging, Vol.7(10), pp.983-990
- DOI
- 10.1016/j.jcmg.2014.05.011
- PMID
- 25240450
- NLM abbreviation
- JACC Cardiovasc Imaging
- ISSN
- 1936-878X
- eISSN
- 1876-7591
- Language
- English
- Date published
- 10/01/2014
- Academic Unit
- Obstetrics and Gynecology
- Record Identifier
- 9984848509902771
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