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

Area of Science:

• Cardiology
• Medical Education
• Diagnostic Imaging

Background:

• Clinicians debate the optimal timing of clinical history delivery relative to bedside testing.
• The impact of history consistency (concordant vs. discordant) on diagnostic accuracy is not well understood.

Purpose of the Study:

• To investigate how the timing (before vs. after) and consistency (concordant vs. discordant) of clinical history affects diagnostic accuracy in focused bedside echocardiography.
• To assess the impact on clinical management decisions.

Main Methods:

• Thirty-two cardiology residents performed bedside echocardiograms on a Vimedix 3D mannequin.
• Clinical histories were provided either before or after image acquisition and were either concordant or discordant with the eventual diagnosis.
• Participants provided a diagnosis and management plan.

Main Results:

• Overall diagnostic accuracy was 63%.
• Providing concordant clinical history before testing significantly improved accuracy.
• Providing discordant clinical history before testing significantly diminished accuracy (OR, 0.35; 95% CI, 0.16-0.80).
• History timing had no significant impact if provided after image acquisition.
• Appropriate management was chosen less often with discordant histories (OR, 0.25; 95% CI, 0.11-0.57).

Conclusions:

• Receiving discordant clinical information before bedside echocardiography can negatively impact diagnostic accuracy.
• The findings suggest that providing clinical history after echocardiography may be a superior strategy for enhancing diagnostic precision.