Original articleRoutinely adding ultrasound examinations by pocket-sized ultrasound devices improves inpatient diagnostics in a medical department
Introduction
Despite the heavy arsenal of diagnostic modalities available in hospitals, autopsies have revealed major diagnostic errors on 30% of patients [1], [2]. Thus, there is a need for improvement in diagnostic accuracy. Ultrasonography performed bedside (point-of-care ultrasonography) by the clinician can rapidly provide diagnostic images as a supplement to clinical findings. This may decrease medical errors [3].
The last two decades have dramatically changed the quality and portability of ultrasound scanners [4], [5], [6]. In the hands of experts, echocardiography with hand-carried and the new pocket-sized ultrasound devices have been shown to be feasible and accurate [7], [8], [9], [10], [11], [12]. Pocket-sized ultrasound devices fit in a white coat pocket, they are priced below $10,000 and they can be operated easier than a standard smart-phone. These devices may serve as efficient tools during busy ward rounds and thus, may provide a more efficient diagnostic algorithm and have the potential to rearrange inpatient workflow. However, clinical evaluation studies are scarce.
Thus, we aimed to study the diagnostic influence of focused cardiac and abdominal screening with pocket-sized ultrasound devices in an unselected group of patients admitted to a medical department.
Section snippets
Study population
Patients admitted to the department of medicine at the non-university Levanger Hospital in Norway were screened with a pocket-sized ultrasound device. The department is sectioned into wards for cardiology, nephrology, gastroenterology, hematology and infectious diseases, pulmonary diseases, and geriatric and cerebrovascular diseases. The inclusion of patients was restricted to preset dates where one of three participating internists/cardiologists was the specialist on call for general medicine.
Results
Table 1 shows the baseline data of the 196 patients included in the study (111 men and 85 women). Mean ± SD (range) age was 68.1 ± 15.0 (20–95) years. The distribution of age was positively skewed compared to a normal distribution. Atrial fibrillation was present in 32 (16%) of the patients at admission, hypertension was present in 69 (35%) patients and 32 (16%) had known diabetes mellitus. Cardiovascular disease defined as at least one of the following diagnoses; myocardial infarction, angina
Discussion
By routinely adding a cardiac and focused abdominal ultrasound screening to the standard diagnostic examinations performed in the emergency room, the principal diagnosis, and thereby the treatment, was significantly corrected in nearly 1 in 5 (18%) of patients. Additionally, 20% had their primary diagnosis verified and in 9% an additional diagnosis of certain importance was made. Overall, the pocket-sized ultrasound screening of mean 6.8 min was of diagnostic importance in approximately half of
Conclusion
By adding a pocket-sized ultrasound examination with B-mode and color flow imaging of < 10 min to usual care diagnostics, we made important diagnostic changes in 1 of 5 patients admitted to a medical department, resulting in a completely different treatment strategy without time delay. Routinely adding a cardiac and abdominal ultrasound screening has the potential to rearrange inpatient workflow and diagnosis.
Learning points
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Despite a wide array of diagnostic modalities, clinical diagnostics are still sub-optimal and autopsy studies have revealed major diagnostic errors in a significant amount of patients treated at hospital.
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Point-of-care ultrasound performed by clinicians may be a useful supplement in the treatment and assessment of certain patients.
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By adding a cardiovascular and focused abdominal ultrasound examination of mean 6.8 min by pocket-sized ultrasound, we correctly assessed cardiac and abdominal
Conflict of interest
None declared.
Acknowledgements
We thank the physicians and nurses at Levanger hospital for assistance with inclusions and data collection. The Norwegian University of Science and Technology and Nord-Trondelag Health Trust, both Norway, funded this study. OC Mjolstad, H Dalen and BO Haugen hold positions at the Medical Imaging Laboratory, NTNU, a Centre of Research-based Innovation that is funded by the Research Council of Norway and industry. One of the industry partners is GE Vingmed Ultrasound. The Centre has a total
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