clinical utility and cost effectiveness of a personal ultrasound imager for cardiac evaluation during consultation rounds in patients with suspected cardiac disease - lithium ion battery cost

Objective: to evaluate the clinical utility and cost-effectiveness of individual ultrasound imagers (PUI)
During the consultation rounds of the heart assessment of suspected heart patients.
Methods: 107 non-selected patients
Department of Cardiology (55% men)
Participated in the study.
After the physical examination, the consultant cardiologist used PUI to study the ultrasound heartbeat map.
The final report was immediately handed over to the referral physician.
A study was subsequently conducted in all patients using standard ultrasound heartbeat devices (SED).
For each patient, a consultant cardiologist points out whether the findings of the PUI are sufficient for a final diagnosis.
The total cost when using a full-ultrasound heartbeat is compared to the cost when using PUI.
The time interval from request to diagnosis is also compared. Results: at 84 (78. 5%)
The patient did not consider it necessary to have further examination with SED.
23 patients21. 5%)
Due to the need for information on blood flow dynamics, further detailed examination with SED is required.
The anomaly detection between the two devices has a good consistency (96%).
The total cost is EUR 132 per SED patient and EUR 75 per PUI patient.
Using PUI can result in 33, according to this study.
Total cost decreased by 4%.
The average time of the author's institution from request to diagnosis is four days of SED and the average time of PUI is immediate to save additional potential costs.
Conclusion: immediately performing an ultrasound heartbeat assessment during rounds can significantly save costs and shorten the diagnostic time.
We studied 107 consecutive patients with suspected heart disease (55% men)with a mean (SD)age of 53 (17)
Over the years, cardiologists have been asked to consult them.
Research design the main inclusion criteria for this study are
The heart Department performed a heart assessment on the patient.
In addition to the physical examination, the consultation cardiologist at the patient's bedside conducted an ultrasound heartbeat study of the PUI.
The final heart report was immediately handed over to the referral physician for a management decision.
The consultant cardiologist, after conducting a clinical examination and PUI study of the patient, pointed out that an ultrasound heartbeat study with SED was needed.
As part of the study, all patients also passed SED (
Andover, MA, HP, Sonos 5500, Vingmed, Horten, Norway, USA).
The second investigator turned a blind eye to the PUI inspection results and reported them.
In this study, there was no change in the routine logistic procedure for the ultrasound heartbeat examination.
Ultrasound heartbeat data were obtained in the standard cardiac view and basic linear measurements of the structure and cavity were performed.
4,5 calculated the average cost of normal surgery in patients undergoing a full-ultrasound heartbeat examination and compared with the cost when using PUI.
In addition, the time interval between PUI and SED's heartbeat examination request and final cardiac report was compared.
The study was approved by our institutional Medical Ethics Committee and received written informed consent from all patients.
The PUIThe SonoHeart systemfig 1)
It is a small handheld ultrasonic device with a 2-4 MHz phase array broadband transducer that operates on a rechargeable lithium-ion battery or an AC power supply.
The unit integrates two-dimensional control settings similar to SED and color power Doppler flow mapping.
Including calipers, distance measurement is possible.
SonoHeart has storage memory for 50 images and can be connected to a video Order, printer or external monitor.
Download the new tabDownload powerpoint figure 1 SonoHeart device, a handheld ultrasound imaging device (weight 2. 4 kg)
This was used in this study.
Statistical analysis reports descriptive statistics as average (SD)
Or percentage of frequency.
Using weighted k statistics, the consistency of anomaly detection is evaluated from the 2 × 2 table.
K value of 0. 4, between 0. 4–0. 75, and > 0.
According to the classification of Fleiss, 75 people are considered to be poor, fair and good agreements, respectively.
6 In addition, the specificity, sensitivity and positive and negative predictive values of PUI detection abnormalities were calculated.
Results through heart visualization of all patients in PUIIn, visualization sufficient to answer the request was achieved.
Protocol Table 1 lists the most common referral issues that require cardiac assessment.
71 clinical findings were detected by SED (table 2).
The agreement between PUI and SED in identifying exceptions is 96% (κ = 0. 93; table 3).
View this table: View the inline View pop-up table 1 Reasons for 107 cardiac counseling requests in non-heart patients
Heart Department this table: View inline View pop-up table 2 abnormal detection using standard ultrasound heartbeat equipment in 107 patients referred to during consultation with rounface this table: check the consistency of inline View popupTable 3 in patients with abnormal detection between SonoHeart and standard ultrasound heartbeat equipment, showing the number of patients PUI provides to cardiologists, sufficient information about 84 (78. 5%)
Patients seen in the consultation round.
Of the 23 or 107 patients (21. 5%)
Although an ultrasound heartbeat examination was performed with PUI, further detailed examination with SED was considered necessary.
In 18 of these 23 patients, a doppler study is required to assess the severity of reflux or stenosis (16 patients)
And diagnosed with pulmonary hypertension (two patients).
Of the 23 patients, two were asked to perform SED tests to verify severe Wall motor abnormalities, and one was asked to investigate further the enlarged ascending aorta.
Two of the 23 patients had a false positive diagnosis of heart inflammation.
In both cases, there is a clinical suspicion that the referring physician has a cardioid.
Because with PUI, the aortic valve has an echo-intensive presence and an enhanced clinical suspicion, cardiologist asked for further analysis with SED.
SED did not add any further information and, according to the subsequent study of the esophageal ultrasound heartbeat, the diagnosis of carditis was ultimately rejected.
PUI missed two major abnormalities: one was moderate flap closure in patients with left heart function referral problems, and the other was pulmonary hypertension in patients with pulmonary heart disease referral problems.
However, a cardiologist referred a second patient to SED for examination.
Cost-benefit calculation of Pui estimates the average cost of SED research by calculating consultation fees for cardiologists (€72)
And the cost of complete ECG research (€60).
The final cost is 132 euros per patient.
The ultrasound heartbeat examination of the PUI is considered to be part of the physical examination and therefore is not charged.
However, we have included in the final cost the capital investment for this equipment, which is approximately € 15 000.
The five-year depreciation of equipment for this amount is € 3 000 per year, and according to the 1000 patients seen during the annual consultation rounds, the depreciation for each patient is € 3.
Therefore, the cost of using PUI for consultation visits is calculated at € 75 per patient.
Applying this data to our findings, the total cost of 107 ultrasound heartbeat tests using SED's standard procedure was 124 euros.
For PUI, however, the total cost is € 405 as only 23 patients are considered to need further investigation with SED.
Therefore, the cost is reduced by 33 with the use of PUI. Achieved 4%.
In addition, the consultant cardiologist requested that the average time interval between the ultrasound and the final ultrasound heartbeat report be greatly shortened.
At our facility, the average time was four days when standard ultrasound maps were required, while PUI immediately provided the results.
Figure 2 shows the logistic flow chart of the request for ultrasound heartbeat study in hospitalized patients after consultation by a cardiologist.
Download figureOpen in new tabDownload powerpoint figure 2 logistics flow chart used in Erasmus Medical Center, Rotterdam, Netherlands for routine ultrasound heartbeat map research for non-patients
The heart department after consultation with a cardiologist.
Discussion This study describes the potential utility of small handheld ultrasound devices during consultation rounds in evaluating non-hospitalized patients
The heart department suspected of heart disease.
84 patients (78. 5%)
PUI provides effective immediate information to doctors indicating that further examination with SED can be avoided.
Among those patients who believe it is necessary to conduct a complete ultrasound heartbeat study, this is mainly due to the need for a blood flow dynamic assessment via Doppler.
With this feature added to the next generation of PUIs, the patient's demand for SED seen in the consultation round may be further reduced.
Previous studies using limited imaging protocols provided evidence that limited imaging studies were feasible for the diagnosis and evaluation of most important heart diseases (
There were 7 cases of left heart fat disease, 8-11 cases of second-pointed malformation and 12 cases of abdominal aortic aneurysm).
13, 14 this limited ECG strategy can be effectively implemented through small handheld ultrasound devices.
Today, the goal of a small handheld ultrasound device is to combine physical examination with an ultrasound heartbeat at the point of care.
Due to the ultra-portable and easy to use, they are practical when conducting consultation rounds.
In a recent study, our team showed the effectiveness and high accuracy of this small imaging device in assessing pathological morphology and cardiac function, thereby enhancing and expanding the physical examination, A goal-oriented exam is allowed.
These results are further confirmed by current research.
As with all technological breakthroughs, the cost-effectiveness of PUI during the consultation period must be assessed in terms of financial and clinical effectiveness for broad acceptance.
Capital investment in such equipment is economic (
About the 12 th of SED cost)
And low maintenance costs.
1125 non-hospitalized patients in our hospital
On 2001, the heart department underwent an ultrasound.
Therefore, in 2001, the total cost of 1125 consultation visits requiring the use of SED for the ultrasound heartbeat examination was 148 EUR 500.
According to our research, the cost can be reduced to 901 euros (66.
6% of the initial amount)
With the use of PUI.
In our study, 85 patients were pre-operative.
In fact, most of the hospitalized patients in our hospital who underwent cardiac consultation were preoperative patients.
The usual requirement of anesthesiology and surgeons is to assess the function or murmur of systolic blood pressure, which can be answered reliably by an ultrasound heartbeat examination.
Therefore, the standard approach for these patients is to require an ultrasound heartbeat study after a physical examination.
Immediate answers to requests can prevent potential delays in patients planning surgery, resulting in cost savings.
But this is only a hypothesis to be studied.
Recently, Kimura and his colleague 15 reported that the result of the initial limited ultrasound heartbeat examination with abnormalities in the emergency department was that the patient was hospitalized for a long time (
More than two days).
In addition, their study showed that in the environment of the emergency department, limited ECG examinations had better diagnostic accuracy in identifying cardiac abnormalities than physical examinations.
This study was conducted by a cardiologist with experience in the ultrasound.
In the consultation wheel, immediate decision-making diagnosis based on the ultrasound heartbeat examination and PUI requires Level II or Level III training for the ultrasound heartbeat.
Kimura and his colleagues have demonstrated that it is feasible to train health care providers to obtain the star-to-star axis and explain significant anomalies.
However, training and licensing
Cardiologists using these devices will be an important issue for the future.
In this study, we did not specifically discuss the impact of using PUI on length of stay.
This may be the basis for future research.
The PUI used for this study did not obtain a Doppler pattern for the data of the blood flow dynamics.
In the new generation of PUIs, spectrum Doppler and color Doppler are now integrated together.
Conclusion during consultation rounds, PUI can help with immediate diagnosis at the bedside, thus shortening the diagnosis time, the efficacy is equivalent to SED and the cost is lower.
REFERENCES Hu BS, Altiel F, Popp RL.
Effectiveness of limited training in cardiac ultrasound examination for cardiovascular diagnosis.
Circular 1996; 94(suppl):I253.
OpenUrlMangione S of Nimman LZ.
Heart auscultation skills of internal medicine and family practice students: Comparison of diagnostic ability. JAMA1997; 278:717–22.
Of OpenUrlCrossRefPubMedWeb Science Popp RL.
Future Physical Examination: An ultrasound heartbeat as part of the assessment.
ACC Curr J. Rev1998; 7:79–81.
Domvourvouri EC, Poldermans D, desut J, etc.
Experience in using an ultrasound stethoscope.
Ultrasound heartbeat map; 15:80–5.
OpenUrlCrossRefPubMedWeb JRTC Science alimroelandt.
Personal ultrasound imaging machine (
Ultrasound stethoscope.
A revolution in physical heart diagnosis!
Eur Heart j2003; 23:523–7.
OpenUrlFREE full text
Statistical Method of rate and proportion, version 2nd.
New York: Willie, 1981.
Kraweidenbener EJ, Krauss MD, Waller BF, etc.
Screening Ultrasound maps were included in pre-participation examinations.
Clin J Sport Med1995; 5:86–9.
Scientific OpenUrlPubMedWeb froshep SG, Frohlich ED.
Limited ultrasound of left ventricular fat in hypertension.
Hypertension1997; 29:560–3.
OpenUrlFREE full text Black HR, Weltin G, Jaffe CC.
Limited ultrasound heartbeat: improvement of standard ultrasound heartbeat for routine evaluation in patients with systemic hypertension.
This is J. Cardiol1991; 67:1027–30.
EC of OpenUrlCrossRefPubMedWeb ScienceVourvouri, Poldermans D. Shenkel AFL, etc.
Check left heart enlargement with hand
Handheld ultrasound equipment.
Eur Heart j2003; 23:1516–21.
OpenUrlAbstract/free full text shushub C, Tajik AJ, Sheps SG. Value of two-
Three-dimensional ultrasound and Doppler examination in the assessment of patients with hypertension: a preliminary study.
Ultrasound heartbeat map; 8:280–4.
Kimura BJ, Scott R, Willis CL, etc.
Accuracy and cost
Single effectiveness
Ultrasound heartbeat screening suspected sagging of the mitral membrane. Am J Med2000; 108:331–3.
Bruce CJ, Spittell PC, Montgomery SC, etc.
Personal ultrasound imaging: Screening of abdominal aortic aneurysm.
Ultrasound heartbeat map; 13:674–9.
EC, Poldermans D. Shenkel AF and so on of OpenUrlCrossRefPubMedWeb Science Limited Vourvouri.
Screening of abdominal aortic aneurysm by hand
Handheld ultrasound equipment. A pilot study.
Internal surgery of Eur J. Vasc; 22:352–4.
Beijing, Bocchicchio mi, Willis CL, and so on.
Heart ultrasound screening for suspected heart disease patients in the emergency department. Am Heart J2001; 142:324–30.
Stewart WJ, Aurigemma GP, Bierman FZ, etc.
Ultrasound heartbeat training-Task Force 4 of the American Society of Cardiology: training guide for adult cardiovascular medicine: core cardiology training seminar (COCATS).
I'm Cole Kadir 1995; 25:16–23.