A Hand Carried Ultrasound Device in the Outpatient Cardiology Clinic Reduces the Need for Standard Echocardiography

Paolo Trambaiolo ¹, Federica Papetti ¹, Alfredo Posteraro ¹, Elisabetta Amici ¹, Mara Piccoli ¹, Elena Cerquetani ¹, Guglielmo Pastena ¹, Giancarlo Gambelli ¹ and Alessandro Salustri ^1*

¹ Policlinico Luigi Di Liegro, Italy

^* To whom correspondence should be addressed. E-mail: salustri{at}jnet.it.

Accepted 27 July 2006

Abstract

Aim We sought to assess the potential value and cost-effectiveness of a hand carried ultrasound (HCU) device in our outpatient cardiology clinic.

Methods 222 consecutive patients were prospectively enrolled in the study. When standard echocardiography (SE) was specifically indicated on the basis of clinical history, ECG and physical examination, the same cardiologist (level-2 or level-3 training) immediately performed a HCU examination. Then, the cardiologist re-assessed the clinical scenario in order to confirm or cancel the SE request according to the information provided by HCU. The SE examination was performed by a sonographer and examined in a blinded fashion by a cardiologist expert in echocardiography. Findings from both examinations were compared.

Results HCU was performed in 108/222 patients and a definite diagnosis was established in 34 of them (31%), thus making SE examination potentially avoidable. In the 74 patients with inconclusive HCU and for whom SE was still indicated, the decision was mainly dictated by the lack of spectral Doppler modality in the HCU system. HCU and SE findings were compared and the overall agreement between the two devices for diagnosis of normal/abnormal echocardiograms was 73% (kappa = 0.4). On the basis of the potentially avoided SE examinations and the obviated need for a second cardiac consultation, a total cost saving of Euro 2142 per 100 patients referred for echocardiography was estimated.

Conclusions The use of a simple HCU device in the outpatient cardiology clinic allows to make a reliable diagnosis in one third of the patients referred for echocardiography, and translates into cost and time saving benefits.

Keywords: Hand-carried ultrasound device, Outpatient clinic, Ultrasound

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