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The potential of point-of-care ultrasound by non-experts to improve diagnosis and patient care
  1. Marcia Melo Barbosa1,2,
  2. Maria Carmo P Nunes2
  1. 1Hospital Socor, Belo Horizonte, Minas Gerais, Brazil
  2. 2Hospital das Clinicas of the Federal University of Minas Gerais, Belo Horizonte, Minas Gerais, Brazil
  1. Correspondence to Dr Marcia de Melo Barbosa, Conde do Rio Pardo, 288, Nova Lima, MG 34000-000, Brazil; marciamelobarbosa{at}gmail.com

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Point-of-care ultrasound has been increasingly used in several clinical settings to improve diagnosis and patient care. Over the past two decades, the development of new digital technology and miniaturisation of ultrasound devices have provided high-quality assessment of the cardiovascular system, which complement the traditional physical examination. Although this new diagnostic methodology has high feasibility and accuracy when performed by experts, its use by non-experts is an interesting alternative that is becoming common practice. Two published Heart studies address the use of point-of-care ultrasound performed by non-experts in different clinical scenarios are presented.

Point-of-care ultrasound for rheumatic heart disease screening

The diagnosis of subclinical rheumatic heart disease (RHD) is uncertain, especially without a definite history of acute rheumatic fever. The prevalence is based on systematic screening studies using different methodology to identify structural or functional valve abnormalities. However, given the challenges associated with large-scale screening and the criteria used for the diagnosis of RHD, its real prevalence is not known.

The first screening programme to diagnose RHD, based on clinical auscultation, included 16 low/middle-income countries and gave an overall prevalence of 2.2 per 1000.1 Auscultation alone has a poor sensitivity to detect RHD, even when performed by experienced cardiologists. It has been consistently shown that echo detection of RHD is much more sensitive than auscultation. A study in Cambodia and Mozambique which examined more than 5000 children showed that auscultation failed to detect 90% of the cases detected by echocardiography.2 However, the main question that remains to be addressed is the natural history of these echocardiographically detected subclinical RHD.

More recently, a systematic review and meta-analysis assessing the effect of different screening methods on estimated prevalence of RHD showed that echocardiographic screening had a four-time higher rate of subclinical disease detection, compared with clinical screening.3 However, echo screening is still cost-prohibitive in places where RHD …

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