Incremental Value of Pocket-Sized Echocardiography in Addition to Physical Examination during Inpatient Cardiology Evaluation: A Multicenter Italian Study (SIEC)
Incremental Value of Pocket-Sized Echocardiography in Addition to Physical Examination during Inpatient Cardiology Evaluation: A Multicenter Italian Study (SIEC)
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DOI：
10.1111/echo.12910
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发表时间：
2015-10-01
影响因子：
1.5
通讯作者：
Carerj, Scipione
中科院分区：
文献类型：
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作者：
Di Bello, Vitantonio;La Carrubba, Salvatore;Carerj, Scipione
背景：我们前瞻性地评估了口袋大小的超声心动图（PSE）设备在心脏病学会诊期间的增量价值，以及体格检查、心电图阅读和胸部x线检查。方法：共443例连续患者（53%为男性），经床边会诊，进行体格检查、心电图和CXR检查，随后进行PSE检查。医生完成了详细的问卷调查（临床和超声心动图数据，扫描时间，异常结果）。生成受试者工作特征（ROC）曲线分析，检验不同方法的预测判别值。PSE检查的增量值与单独的临床就诊或与ECG结果相结合的增量值表示为全局卡方值。结果：仅有23.5%的病例PSE检查不影响明确诊断，而25.3%的诊断得到PSE的确认和验证。应用PSE丰富临床诊断的病例占21.9%，改变诊断的病例占26.2%。体检+心电图结果的曲线下面积（AUC）（灵敏度：80%，特异性：67%）显著高于单独体检（灵敏度：75%，特异性：62%）（P < 0.0002）， PSE结果的AUC（灵敏度：88%，特异性：86%）显著高于体检+心电图结果（P < 0.0001）。与单独的临床就诊或ECG结果相比，PSE结果与临床和ECG结果相结合，在心脏病学会诊中具有显著的增量诊断价值（P < 0.0001）。结论：PSE在床边心内科会诊中具有增量诊断价值，增加了正确诊断的数量，减少了超声心动图的常规使用。
Background: We prospectively assessed the incremental value of a pocket-sized echocardiography (PSE) device during cardiology consultations, in addition to physical examination, ECG reading, and chest x-ray. Methods: A total of 443 consecutive patients (53% men), referred for bedside consultations, underwent physical examination, ECG, and CXR, followed by PSE examination. The physician completed a detailed questionnaire (clinical and echocardiographic data, scanning time, abnormal results). Receiver operating characteristic (ROC) curve analysis was generated to test the predictive discrimination value of the different methods. The incremental value of PSE examination compared to clinical visit alone or combined with ECG results was expressed as a global chi-square value. Results: The PSE examination did not influence the definitive diagnosis in only 23.5% of cases, while 25.3% of the diagnoses were confirmed and verified by PSE. The clinical diagnosis was enriched by PSE in 21.9% of cases, and the diagnosis was changed in 26.2%. The area under curve (AUC) of physical examination + ECG results (sensitivity: 80%; specificity: 67%) was significantly higher than physical examination alone (sensitivity: 75%; specificity: 62%) (P < 0.0002), and the AUC of PSE results (sensitivity: 88%; specificity: 86%) was significantly higher than physical examination + ECG results (P < 0.0001). The PSE results, combined with clinical and ECG results, had a significant incremental diagnostic value during cardiology consultation when compared to the clinical visit alone or with ECG results (P < 0.0001). Conclusions: PSE had an incremental diagnostic value during bedside cardiology consultation, increasing the number of appropriate diagnoses and reducing the routine use of echocardiography.