Garrett N Andersen1, Torbjørn Graven2, Kyrre Skjetne2, Ole C Mjølstad2, Jens O Kleinau2, Øystein Olsen2, Bjørn O Haugen2, Håvard Dalen2. 1. Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway (G.N.A., T.G., K.S., J.O.K., Ø.O., H.D.); Medical Imaging Laboratory (G.N.A., O.C.M., B.O.H., H.D.), Department of Circulation and Medical Imaging (G.N.A., O.C.M., B.O.H., H.D.), and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; and Clinic of Cardiology, St Olav Trondheim University Hospital, Trondheim, Norway (O.C.M., B.O.H.). garrett.andersen@gmail.com. 2. Levanger Hospital, Nord-Trøndelag Health Trust, Levanger, Norway (G.N.A., T.G., K.S., J.O.K., Ø.O., H.D.); Medical Imaging Laboratory (G.N.A., O.C.M., B.O.H., H.D.), Department of Circulation and Medical Imaging (G.N.A., O.C.M., B.O.H., H.D.), and Department of Cancer Research and Molecular Medicine, Norwegian University of Science and Technology, Trondheim, Norway; and Clinic of Cardiology, St Olav Trondheim University Hospital, Trondheim, Norway (O.C.M., B.O.H.).
Abstract
OBJECTIVES: We aimed to investigate the potential benefit of adding goal-directed ultrasound examinations performed by on-call medical residents using a pocket-size imaging device in patients admitted to a medical department. METHODS: A total of 992 emergency admissions to the medical department at a nonuniversity hospital in Norway were included. Patients admitted on dates with an on-call medical resident randomized to use apocket-size imaging device were eligible for pocket-size cardiac and abdominal ultrasound examinations or standard care. The cardiac examination included estimation of right and left ventricular sizes and global systolic function and regional left ventricular systolic function, evaluation for pleural and pericardial effusion, and valvular disease. The abdominal examination looked for signs of gross abnormalities of the liver, gallbladder, abdominal aorta, inferior vena cava, and urinary system. Six of 12 medical residents with limited ultrasound experience were randomized to perform the examinations. Diagnostic corrections were made, and findings were confirmed by reference standard diagnostics. RESULTS:A total of 199 patients were examined. Median times used were 5.7 minutes for the cardiac examination and 4.7 minutes for the abdominal examination. In 13 patients (6.5%), the examination resulted in a major change in the primary diagnosis. In 21 patients (10.5%), the diagnosis was verified, and in 48 (24.0%), an additional important diagnosis was made. CONCLUSIONS: By implementing pocket-size ultrasound examinations that took less than 11 minutes to the usual care, we corrected, verified, or added important diagnoses in more than 1 of 3 emergency medical admissions. Point-of-care examinations with a pocket-size imaging device increased medical residents' diagnostic accuracy and capability.
RCT Entities:
OBJECTIVES: We aimed to investigate the potential benefit of adding goal-directed ultrasound examinations performed by on-call medical residents using a pocket-size imaging device in patients admitted to a medical department. METHODS: A total of 992 emergency admissions to the medical department at a nonuniversity hospital in Norway were included. Patients admitted on dates with an on-call medical resident randomized to use a pocket-size imaging device were eligible for pocket-size cardiac and abdominal ultrasound examinations or standard care. The cardiac examination included estimation of right and left ventricular sizes and global systolic function and regional left ventricular systolic function, evaluation for pleural and pericardial effusion, and valvular disease. The abdominal examination looked for signs of gross abnormalities of the liver, gallbladder, abdominal aorta, inferior vena cava, and urinary system. Six of 12 medical residents with limited ultrasound experience were randomized to perform the examinations. Diagnostic corrections were made, and findings were confirmed by reference standard diagnostics. RESULTS: A total of 199 patients were examined. Median times used were 5.7 minutes for the cardiac examination and 4.7 minutes for the abdominal examination. In 13 patients (6.5%), the examination resulted in a major change in the primary diagnosis. In 21 patients (10.5%), the diagnosis was verified, and in 48 (24.0%), an additional important diagnosis was made. CONCLUSIONS: By implementing pocket-size ultrasound examinations that took less than 11 minutes to the usual care, we corrected, verified, or added important diagnoses in more than 1 of 3 emergency medical admissions. Point-of-care examinations with a pocket-size imaging device increased medical residents' diagnostic accuracy and capability.
Authors: Ximena Cid-Serra; Alistair Royse; David Canty; Douglas F Johnson; Andrea B Maier; Tim Fazio; Doa El-Ansary; Colin F Royse Journal: JAMA Netw Open Date: 2021-12-01
Authors: Anna Katarina Hjorth-Hansen; Malgorzata Izabela Magelssen; Garrett Newton Andersen; Torbjørn Graven; Jens Olaf Kleinau; Bodil Landstad; Lasse Løvstakken; Kyrre Skjetne; Ole Christian Mjølstad; Havard Dalen Journal: BMJ Open Date: 2022-10-13 Impact factor: 3.006