Blog | Wednesday, June 11, 2014

QD: News Every Day--Pocket ultrasound devices may increase dyspnea diagnoses

Pocket ultrasound devices helped internal medicine residents improve diagnostic accuracy of dyspnea, and extended training increased residents’ accuracy even further, a study found.

To assess the feasibility of training internal medicine residents with a pocket ultrasound device, researchers at Beth Israel Medical Center performed a prospective, observational trial of volunteer internal medicine residents who received 2 90-minute training sessions, and among 2 residents who received an additional 2 weeks of training, from September 2012 to August 2013.

Following lung ultrasound performance, an ultrasound diagnosis was recorded using clinical and sonographic findings. Clinical diagnosis and ultrasound diagnosis were compared using attending physician’s final discharge diagnosis as the gold standard, and the receiver operating area under the curve (AUC) was calculated.

Results appeared in the Journal of Hospital Medicine.

The AUC for ultrasound diagnosis was significantly higher than that for clinical diagnosis (0.87 vs. 0.81, P<0.01). Lung ultrasound increased the diagnosis of 4 causes of dyspnea: chronic obstructive pulmonary disease (0.73 to 0.85, P=0.06), acute pulmonary edema (0.85 to 0.89, P=0.49), pneumonia (0.77 to 0.88, P=0.01), and pleural effusions (0.76 to 0.96, P<0.002).

First listed author Jason Filopei, MD, ACP Resident/Fellow Member, and colleagues wrote, that because sensitivity and specificity were larger in the extended training group, it is important for there to be enough training to demonstrate the devices’ usefulness. “Although a 2-week critical care ultrasound elective may not be possible for all residents, perhaps training of intensity somewhere in between these 2 levels would be most feasible,” they wrote.

Read more from ACP Internist about how to apply pocket ultrasound devices and on how to teach medical staff to use them with an economical, build-it-yourself simulator.