Pocket-sized point-of-care cardiac ultrasound devices : Role in the emergency department

Acute breathlessness accounts for 8% of accident and emergency attendances. Point-of-care cardiac ultrasound (US) effectively reduces time to diagnosis. Fast and practical information via pocket-sized cardiac US devices may better the diagnosis in this complex patient group.

We prospectively enrolled 40 consecutive patients presenting with shortness of breath at the emergency department (ED). Divided into two groups were all adult patients over 18 with acute breathing difficulties (triage category 1-3): 21 patients received a short focused cardiac US scan using a pocket-sized Vscan and 19 patients received no scan. Data were obtained regarding the time taken for diagnosis and treatment, patient length of stay, inpatient mortality and 30-day mortality.

In the scanned group 33% of patients had significantly abnormal Vscan results that had the potential to aid diagnosis and guide management. The difference of 20 min between the means of the time to diagnosis between the groups was not significant.

The individual knowledge of UK emergency physicians regarding basic echocardiography varies greatly. An intuitive approach following a brief tutorial on pocket-size echocardiography was shown to improve diagnostic accuracy in addition to history taking and physical examination by medical students and junior doctors with no previous exposure to echocardiography. Increasing evidence shows the feasibility and benefit of FOCUS echo in the ED and the pocket-sized devices could play a large role.

The Vscan is a practical, portable device that provides rapid diagnostic information. One third of patients had significant findings on the scans to possibly aid diagnosis and prevent misdiagnosis. This has the potential to reduce time to diagnosis in the ED.