Screening cardiac ultrasonographic examination in patients with suspected cardiac disease in the emergency department

Background/Objective Our purpose was to evaluate the utility of a brief scr eening cardiac ultrasonographic (SCU) examination. We prospectively compare d the SCU with conventional clinical evaluation in 124 emergency department (ED) patients with suspected cardiac disease. Furthermore, we assessed the impact and quality of SCU examinations as obtained by briefly trained ED p ersonnel (EP). Methods Patients underwent clinical evaluation by an ED physician and SCU e xamination by a sonographer or cardiologist. Patient disposition, hospital stay length, and the number of full echo examinations were compared with th e presence of significant findings on SCU. In patients who received a full echocardiogram during hospitalization, results of the initial clinical exam ination were compared with results of the SCU examination in the diagnosis of significant findings. A similar analysis, but with quality assessment, w as performed on only those SCU examinations acquired by 4 EP. Results Of the 124 patients enrolled in the main study, 40 of 124 (32%) had significant findings on SCU. Of patients with abnormal SCUs versus normal SCUs, 16 of 40 (40%) versus 18 of 84 (21%) had hospital stay lengths >2 day s (P less than or equal to .05). Using the 36 inpatient full echo studies o btained for standard indications during hospitalization as a gold standard, initial clinical examination identified only 7 of 30 (23%) significant fin dings and had 16 false-positive diagnoses, whereas SCU identified 22 of 30 (73%) with 8 false positives. Although similar study results occurred with interpretation of 68 SCUs obtained by EP, quality was achieved in only 55% ED personnel versus 97% of sonographer-obtained SCUs (P<.05). Conclusions An SCU examination detects significant findings misdiagnosed on initial clinical evaluation in the ED and provides prognostic data regardi ng length of hospital stay.