Handheld ultrasonographic devices with clinical examination may help diagnose pulmonary and cardiac diseases: JAMA
In sub-Saharan Africa, agreement between clinicians using a handheld ultrasonographic device and expert sonographers using a high-end ultrasonographic machine regarding lung ultrasonography findings has yet to be studied.
According to an Original Investigation on Imaging published in JAMA Network Open, researchers mentioned that handheld ultrasonographic devices used in addition to clinical examination may support clinicians in diagnosing cardiac and pulmonary diseases in rural sub-Saharan Africa.
The study's objective was to evaluate the agreement between primary care clinicians who had undergone training in lung ultrasonography, board-certified expert sonographers, and senior physicians regarding ultrasonographic findings and diagnoses. The study was conducted in a rural Tanzanian referral centre from February 1, 2022, to April 30, 2023. The participants were five or older with respiratory symptoms and at least two distinct respiratory signs. Participants underwent a clinical examination, lung ultrasonography by a clinician, lung ultrasonography by an expert sonographer, and chest radiography by a senior physician.
The clinicians received two hours of instruction and three two-hour clinical training sessions on handheld lung ultrasonographic devices, while the expert sonographers were board-certified. The primary outcomes measured were the percentage agreement and Cohen κ coefficient for sonographic findings and diagnoses between the different groups.
Key findings from the study are:
• 438 participants of 54 years, including 51 %, were included in the study.
• The median percentage agreement of ultrasonographic findings between clinicians and expert sonographers was 93%, κ ranging from −0.003 to 0.83.
• Median (range) agreement of diagnoses between clinicians and expert sonographers was 90%, with κ ranging from −0.002 to 0.76.
• Between clinicians and senior physicians, the median (range) agreement of diagnoses was 89%. κ ranged from −0.008 to 0.76.
• Between clinicians and senior physicians, diagnosis agreements for heart failure, definite/probable tuberculosis, and viral and bacterial pneumonia were 85%, 78%,50% and 56% (κ, 0.06) for bacterial pneumonia with κ values of 0.69, 0.57, 0.002 and 0.06 respectively.
This study's findings indicate that handheld ultrasonographic devices, when used alongside clinicians trained in lung ultrasonography, history, and physical examination, can help identify ultrasonographic findings and determine the cause of a respiratory issue.
Reference:
Katende A et al. Use of a Handheld Ultrasonographic Device to Identify Heart Failure and Pulmonary Disease in Rural Africa. JAMA Netw Open. 2024;7(2):e240577. doi:10.1001/jamanetworkopen.2024.0577
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