• Brian P Lucas, Carolina Candotti, Bosko Margeta, Arthur T Evans, Benjamin Mba, Joshua Baru, Joseph K Asbury, Abdo Asmar, Rudolf Kumapley, Manish Patel, Shane Borkowsky, Sharon Fung, and Marjorie Charles-Damte.
• Department of Medicine, Stroger Hospital of Cook County and Rush Medical College, Chicago, Illinois, USA. brian_lucas@rush.edu
• J Hosp Med. 2009 Jul 1; 4 (6): 340-9.

BackgroundThe duration of training needed for hospitalists to accurately perform hand-carried ultrasound echocardiography (HCUE) is uncertain.ObjectiveTo determine the diagnostic accuracy of HCUE performed by hospitalists after a 27-hour training program.DesignProspective cohort study.SettingLarge public teaching hospital.PatientsA total of 322 inpatients referred for standard echocardiography (SE) between March and May 2007.InterventionBlinded to SE results, attending hospitalist physicians performed HCUE within hours of SE.MeasurementsDiagnostic characteristics of HCUE as a test for 6 cardiac abnormalities assessed by SE: left ventricular (LV) systolic dysfunction; severe mitral regurgitation (MR); moderate or severe left atrium (LA) enlargement; moderate or severe LV hypertrophy; medium or large pericardial effusion; and dilatation of the inferior vena cava (IVC).ResultsA total of 314 patients underwent both SE and HCUE within a median time of 2.8 hours (25th to 75th percentiles, 1.4 to 5.1 hours). Positive and negative likelihood ratios for HCUE increased and decreased, respectively, the prior odds by 5-fold or more for LV systolic dysfunction, severe MR regurgitation, and moderate or large pericardial effusion. Likelihood ratios changed the prior odds by 2-fold or more for moderate or severe LA enlargement, moderate or severe LV hypertrophy, and IVC dilatation. Indeterminate HCUE results occurred in 2% to 6% of assessments.ConclusionsThe diagnostic accuracy of HCUE performed by hospitalists after a brief training program was moderate to excellent for 6 important cardiac abnormalities.

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