Limited bedside echocardiography by emergency physicians for diagnosis of diastolic heart failure.

INTRODUCTION: The identification of diastolic heart failure (DHF) is important for determining the prognosis of congestive heart failure patients. This study attempted to determine the accuracy of emergency physicians who performed bedside echocardiography (BECH) in patients with diastolic dysfunction. METHODS: Three attending emergency physicians underwent 3 h of didactic and 3 h of hands-on training taught by a cardiology specialist for the echocardiographic diagnostic criteria of DHF. Between February and April 2010, the emergency physicians performed BECH for patients presenting with dyspnoea, and echocardiographic views were recorded. Our gold standard for the diagnosis of diastolic dysfunction was the cardiologists' echocardiography report. Results were compared with χ(2) testing. RESULTS: Of the 69 enrolled patients, 51 were diagnosed as having diastolic dysfunction by emergency physicians. The sensitivity of BECH was 89% (77-95) and specificity was 80% (51-95) with 95% CI. The accuracy of the emergency physicians' echocardiographic diagnosis was 87%. CONCLUSION: BECH performed by emergency physicians may serve as an objective, rapid, non-invasive tool in the assessment of patients presenting with dyspnoea in ED.

Paramedic-performed Focused Assessment with Sonography in Trauma (FAST) in the emergency department.

BACKGROUND: Our objective was to evaluate the accuracy of paramedic-performed Focused Assessment with Sonography in Trauma (PFAST) for detection of free fluid in patients admitted to the Emergency Department (ED) following trauma. METHODS: After four hours of didactic and four hours of hands-on training, four paramedics prospectively evaluated trauma patients. Our gold standard was the official radiologist reports of ultrasonography and computerized abdominal tomography (CAT). The sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of PFAST were calculated and analyzed using SPSS 15.0 with ?2 testing. RESULTS: One hundred and twenty-seven patients were evaluated by the paramedics. Fourteen patients had positive free fluid in the abdomen. Of these, 11 were corroborated by radiology reports and CAT (true positives), and three were found to be negative (false positives). In 113 cases, PFAST was negative for free fluid. Of these, 111 were determined not to have free fluid (true negatives), whereas free fluid was detected by CAT in 2 (false negatives). The sensitivity, specificity, positive and negative likelihood ratios, and diagnostic odds ratio of PFAST were 84.62, 97.37, 32.15, 0.16, and 203.50, respectively. CONCLUSION: Our study shows that paramedics can perform FAST in hospital Eds with a high degree of accuracy.