Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Sorensen, Bjarte; Hunskaar, Steinar

doi:10.1186/s13089-019-0145-4

The Ultrasound Journal

Table 2 Summary of test accuracy findings in echocardiography

From: Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Test	Author	Op.	Year	Country or MA (studies)	Train.	n	Prev (%)	Age (years)	Criterion standard	Sn. (%) (95% CI)	Sp. (%) (95% CI)	LR+ (95% CI)	LR− (95% CI)
MAPSE < 10 mm	Mjølstad et al. [33]	GP	2012	Norway	8 h.	92	NR	73	Cardiologist echo.	83.3 (66.4–92.7)	77.6 (64.1–87.1)	3.72^a	0.746^a
LVH (ventricular wall > 13 mm)	Evangelista et al. [34]	GP	2013	Spain	NR	393	46	71	Cardiologist echo.	89.8 (NR)	98.4 (NR)	56.1^a	0.114^a
LVH (ventricular wall > 13 mm)	Evangelista et al. [35]	GP	2016	Spain	NR	1312	16	67	Cardiologist echo.	71.4 (63.1–79.7)	97.4 (96.7–98.6)	27.5^a	0.29^a
LVEF < 50–55%	Unlüer et al. [41]	EP	2014	Turkey	NR	133	56	70	Cardiologist echo.	98.7 (91.8–99.9)	86.2 (74.1–93.4)	7.15 (3.76–13.6)	0.015 (0.002–0.109)
	Martindale et al. [55]	EP	2016	MA (3)	NR	325	41	NR	Final diagnosis	80.6 (72.9–86.9)	80.6 (74.3–86.0)	4.1 (2.4–7.2)	0.24 (0.17–0.35)
	Shah et al. [42]	EP	2016	Haiti	30 h.	117	40	36	Cardiologist echo.	93.6 (81.4–98.3)	100 (93.5–100)	∞^a	0.064^a
	Farsi et al. [43]	EP	2017	Iran	10 h.	205	51	61	Cardiologist echo.	89 (81–99)	96 (90–99)	22 (8–58)	0.12 (0.07–0.20)
LVEF < 40%	Dehbozorgi et al. [44]	EP	2019	Iran	NR	100	28	58	Final diagnosis (AHF)	100 (88–100)	88 (78–94)	8 (4.34–14.74)	0
LV dysfunction	Evangelista et al. [35]	GP	2016	Spain	NR	1312	4	67	Cardiologist echo.	50.0 (30.4–69.6)	92.7 (91.3–94.2)	6.85^a	0.539^a
LA dilatation	Evangelista et al. [35]	GP	2016	Spain	NR	1312	4	67	Cardiologist echo.	41.5 (25.2–57.8)	97.7 (96.8–98.6)	18.0^a	0.701^a
RVD	Evangelista et al. [34]	GP	2013	Spain	NR	393	22	71	Cardiologist echo.	80.2 (NR)	98.9 (NR)	73.9^a	0.200^a
RVD	Farsi et al. [43]	EP	2017	Iran	10 h.	205	16	61	Cardiologist echo.	98 (94–99)	87 (69–96)	41 (15–109)	0.07 (0.02–0.27)
RVP	Farsi et al. [43]	EP	2017	Iran	10 h.	205	3	61	Cardiologist echo.	100 (52–100)	100 (98–100)	∞^a	0^a
Aortic valve sclerosis	Evangelista et al. [34]	GP	2013	Spain	NR	393	23	71	Cardiologist echo.	81.6 (NR)	98.2 (NR)	45.3^a	0.187^a
Aortic stenosis	Evangelista et al. [35]	GP	2016	Spain	NR	1312	5	67	Cardiologist echo.	50.0 (36.1–64.0)	98.1 (97.0–99.1)	26.3^a	0.510^a
Aortic insufficiency	Evangelista et al. [34]	GP	2013	Spain	NR	393	27	71	Cardiologist echo.	86.1 (NR)	95.7 (NR)	76.9^a	0.145^a
Aortic insufficiency	Evangelista et al. [35]	GP	2016	Spain	NR	1312	4	67	Cardiologist echo.	58.3 (43.3–73.3)	99.0 (98.3–99.6)	58.3^a	0.421^a
Dilated ascending aorta	Evangelista et al. [34]	GP	2013	Spain	NR	393	15	71	Cardiologist echo.	89.1 (NR)	100 (NR)	∞^a	0.109^a
Dilated ascending aorta	Evangelista et al. [35]	GP	2016	Spain	NR	1312	9	67	Cardiologist echo.	54.1 (37.1–70.2)	99.1 (98.4–99.6)	60.1^a	0.463^a
Mitral insufficiency	Evangelista et al. [34]	GP	2013	Spain	NR	393	48	71	Cardiologist echo.	89.1 (NR)	87.2 (NR)	6.96^a	0.125^a
Mitral insufficiency	Evangelista et al. [35]	GP	2016	Spain	NR	1312	6	67	Cardiologist echo.	72.7 (61.2–84.2)	97.7 (96.8–98.6)	31.6^a	0.279^a
Mitral stenosis	Evangelista et al. [35]	GP	2016	Spain	NR	1312	1	67	Cardiologist echo.	62.8 (22.7–100)	98.1 (97.3–98.9)	33.1^a	0.379^a
Tricuspid insufficiency	Evangelista et al. [35]	GP	2016	Spain	NR	1312	4	67	Cardiologist echo.	41.4 (21.7–61.0)	98.9 (98.3–99.5)	37.6^a	0.694^a
Hypertrophic cardiomyopathy	Evangelista et al. [35]	GP	2016	Spain	NR	1312	1	67	Cardiologist echo.	44.4 (6.4–82.5)	99.8 (99.6–100)	222^a	0.557^a
Diastolic heart failure	Unlüer et al. [47]	EP	2012	Turkey	6 h.	69	74	63	Cardiologist echo.	89 (77–95)	80 (51–95)	4.5 (1.6–12)	0.14 (0.06–0.21)
Diastolic heart failure	Ehrman et al. [48]	EP	2015	USA	3 h.	62	52	56	Cardiologist echo.	92 (60–100)	69 (50–83)	2.9	0.12
Restrictive mitral pattern	Nazerian et al. [50]	EP	2010	Italy	4 h.	125	35	78	Final diagnosis of AHF	82 (73–87)	90 (84–94)	8.27 (4.57–15.42)	0.21 (0.14–0.32)
Wall motion abnormality	Farsi et al. [43]	EP	2017	Iran	10 t.	205	33	61	Cardiologist echo.	97 (89–99)	87% (80–92)	8 (5–12)	0.03 (0.01–0.13)
Wall motion abnormality	Croft et al. [52]	EP	2019	USA	NR	75	62	65	Cardiologist echo. or ventriculogram	88 (75–96)	92 (75–99)	11.5 (3.1–43.7)	0.13 (0.05–0.29)
Speckle tracking	Reardon et al. [53]	EP	2018	USA	NR	75	16	52	Cardiologist echo. or final diagnosis ACS	29 (17–46)	88 (72–96)	2.4^a	0.81^a
Pericardial effusion	Mandavia et al. [54]	EP	2001	USA	5 h.	515	20	NR	Cardiologist echo.	96.0 (90.4–98.9)	98.0 (95.8 to 99.1)	48.0^a	0.0408^a
	Farsi et al. [43]	EP	2017	Iran	10 h.	205	10	61	Cardiologist echo.	86 (63–96)	96 (91–98)	20 (10–40)	0.15 (0.05–0.40)
	Shah et al. [42]	EP	2016	Haiti	30 h.	117	8	36	Cardiologist echo.	88.9 (50.7–99.4)	99.1 (94.2–100)	98.8^a	0.112^a
	Bustam et al. [39]	EP	2014	Malaysia	3 h.	100	5	NR	Cardiologist echo.	60 (15^a–95^a)	100 (96^a–100^a)	∞^a	0.40^a

MA, meta-analysis (shown in italics with number of studies in brackets); Op., operators; Train., time spent in didactic intervention; n, size of population; Prev., prevalence; Age, median or mean age in years; Sn., sensitivity; Sp., specificity; CI, confidence interval; LR+, positive likelihood ratio; LR−, negative likelihood ratio; NR, not reported; echo., echocardiography; MAPSE, mitral annular plane systolic excursion; GP, general practitioner; LVH, left-ventricular hypertrophy; LVEF, left-ventricular ejection fraction; EP, emergency physician; LV, left ventricle; LA, left atrial; RVD, right-ventricular dilatation; RVP, right-ventricular pressure
^aCalculated by the authors

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