Diagnostic accuracy of hospitalist-performed hand-carried ultrasound echocardiography after a brief training program

J Hosp Med. 2009 Jul;4(6):340-9. doi: 10.1002/jhm.438.


Background: The duration of training needed for hospitalists to accurately perform hand-carried ultrasound echocardiography (HCUE) is uncertain.

Objective: To determine the diagnostic accuracy of HCUE performed by hospitalists after a 27-hour training program.

Design: Prospective cohort study.

Setting: Large public teaching hospital.

Patients: A total of 322 inpatients referred for standard echocardiography (SE) between March and May 2007.

Intervention: Blinded to SE results, attending hospitalist physicians performed HCUE within hours of SE.

Measurements: Diagnostic 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).

Results: A 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.

Conclusions: The diagnostic accuracy of HCUE performed by hospitalists after a brief training program was moderate to excellent for 6 important cardiac abnormalities.

Publication types

  • Comparative Study
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Aged
  • Clinical Competence / standards
  • Cohort Studies
  • Diagnostic Equipment / standards
  • Echocardiography / instrumentation*
  • Echocardiography / standards*
  • Female
  • Hospitalists / education*
  • Hospitalists / standards*
  • Humans
  • Inservice Training / standards*
  • Male
  • Middle Aged
  • Prospective Studies
  • Time Factors
  • Ventricular Dysfunction, Left / diagnosis
  • Ventricular Dysfunction, Left / diagnostic imaging