Format

Send to

Choose Destination
Can J Cardiol. 2018 Jan;34(1):88-91. doi: 10.1016/j.cjca.2017.10.018. Epub 2017 Oct 31.

Avoiding Clinical Errors With Bedside Echocardiography: A Randomized Clinical Study.

Author information

1
Division of Medicine, Department of Cardiology, University of Toronto, Toronto, Ontario, Canada; Ted Rogers Centre of Excellence in Heart Function, Peter Munk Cardiac Centre, University Health Network, Toronto, Ontario, Canada.
2
Division of Medicine, Department of Cardiology, University of Toronto, Toronto, Ontario, Canada; Division of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
3
Division of Medicine, Mount Sinai Hospital, Toronto, Ontario, Canada.
4
Division of Medicine, Department of Cardiology, University of Toronto, Toronto, Ontario, Canada; Division of Medicine, St-Michael's Hospital, Toronto, Ontario, Canada.
5
Division of Medicine, Department of Cardiology, McMaster University, Hamilton, Ontario, Canada; The Centre for Excellence in Education and Practice (CEEP), Toronto, Ontario, Canada. Electronic address: sibbaldm@hhsc.ca.

Abstract

Clinicians have strong opinions about whether they should be provided the clinical history before or after bedside testing. We hypothesized that diagnostic accuracy is improved when a concordant clinical history is provided before a diagnostic test. To investigate whether the timing (before or after) and the consistency (concordant vs discordant) of the clinical history in the setting of focused bedside echocardiography affects clinician diagnostic accuracy and management decisions. Thirty-two cardiology residents were asked to perform a bedside echocardiogram on a Vimedix 3D mannequin. Half of the histories were provided before echocardiography and half after echocardiography. Half were consistent with the echocardiographic diagnosis (concordant), and half were suggestive of a plausible alternative diagnosis (discordant). Participants were asked for a diagnosis and management plan. The primary outcome was the diagnostic accuracy of the echocardiographic images. The secondary outcome was the management plan. Overall diagnostic accuracy was 63%. If the clinical history was provided before the bedside testing, it significantly improved diagnostic accuracy if it was concordant and it diminished accuracy if it was discordant (odds ratio [OR], 0.35; 95% confidence interval [CI], 0.16-0.80; P = 0.001). Clinical history, whether concordant or discordant, had no significant impact if provided after the images were obtained. Appropriate management was chosen 77% of the time and was chosen less often with discordant compared with concordant histories (OR, 0.25; 95% CI, 0.11-0.57; P = 0.001). Our study suggests a significant downside to clinical information received before echocardiography when the information is discordant, raising the possibility that receiving clinical information after echocardiography may be superior for diagnostic accuracy.

PMID:
29275888
DOI:
10.1016/j.cjca.2017.10.018
[Indexed for MEDLINE]

Supplemental Content

Full text links

Icon for Elsevier Science
Loading ...
Support Center