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Reliability and agreement of point-of-care carotid artery examinations by experts using hand-held ultrasound devices in patients with ischaemic stroke or transitory ischaemic attack.

ABSTRACT: To investigate the reliability and agreement of hand-held ultrasound devices (HUDs) compared with conventional duplex ultrasound (HIGH) in examination for carotid stenosis in patients with suspected transitory ischaemic attack (TIA) or ischaemic stroke. Cardiologists, experienced in carotid ultrasound, examined patients admitted to a community hospital with suspected stroke or TIA. Patients were first examined by an HUD and second by HIGH as per usual care. Different operators performed HUD and HIGH blinded to each other. On clinical discretion, CT angiography (CTA) was performed, and analysed by a radiologist blinded to the results from the ultrasound. Of 80 patients included, 9 (11%) were found to have >50% internal carotid artery (ICA) stenosis on reference examination. Agreement for classification of the degree of ICA stenosis was good for HUD versus HIGH (weighted Kappa 0.76) and HUD versus CTA (weighted Kappa 0.66). Agreement between HUD and HIGH examinations was excellent when ICA was classified as <50% diameter stenosis by HUD (99% agreement), but significantly lower when ICA diameter stenosis was classified as >50% by HUD (OR 0.15, 95% CI 0.06 to 0.42). Overall, HUD tended to overestimate the degree of carotid stenoses rather than underestimate (p=0.048). Hand-held carotid ultrasound performed by experts demonstrated good agreement with conventional duplex ultrasound. The use of HUDs was reliable for ruling out significant carotid artery disease, but less reliable for ruling in significant disease.

SUBMITTER: Saxhaug LM

PROVIDER: S-EPMC8808450 | biostudies-literature | 2022 Feb

REPOSITORIES: biostudies-literature

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Reliability and agreement of point-of-care carotid artery examinations by experts using hand-held ultrasound devices in patients with ischaemic stroke or transitory ischaemic attack.

Saxhaug Lars Mølgaard LM Graven Torbjorn T Olsen Øystein Ø Kleinau Jens Olaf JO Skjetne Kyrre K Ellekjær Hanne H Dalen Havard H

Open heart 20220201 1

<h4>Objectives</h4>To investigate the reliability and agreement of hand-held ultrasound devices (HUDs) compared with conventional duplex ultrasound (HIGH) in examination for carotid stenosis in patients with suspected transitory ischaemic attack (TIA) or ischaemic stroke.<h4>Methods</h4>Cardiologists, experienced in carotid ultrasound, examined patients admitted to a community hospital with suspected stroke or TIA. Patients were first examined by an HUD and second by HIGH as per usual care. Diff ...[more]

PMID: 35105719

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Project description:IntroductionLiterature on prevalence of symptomatic internal carotid artery stenosis is scarce and heterogeneous. Prevalence may have decreased in recent years due to improved management of cardiovascular risk factors. We aim to estimate current prevalence and identify risk factors of ipsilateral internal carotid artery stenosis in patients with recent hemispheric transient ischaemic attack or ischaemic stroke in the Netherlands.Patients and methodsWe included consecutive adult patients admitted to two large hospitals in the Netherlands in 2014 who suffered from amaurosis fugax, retinal ischaemia, transient ischaemic attack or ischaemic stroke in the vessel territory of the internal carotid artery. Primary outcome was presence of ipsilateral internal carotid artery stenosis (degree subdivided following NASCET criteria), as assessed with duplex ultrasonography, computed tomography angiography and/or magnetic resonance angiography. We used univariable and multivariable logistic regression to identify risk factors for the presence of a 50-100% internal carotid artery stenosis.ResultsWe analysed 883 consecutive patients with recent transient ischaemic attack or ischaemic stroke. Of these, 110 (12.5%) had 50-99% ipsilateral internal carotid artery stenosis. Subgroup analyses showed higher prevalence of any degree of internal carotid artery stenosis for male sex and White patients. In adjusted analyses, higher age (odds ratio 1.4/10 years; 95% confidence interval 1.16-1.63), male sex (odds ratio 2.8; 95% confidence interval 1.83-4.19), retinal ischaemia (odds ratio 2.5; 95% confidence interval 1.32-4.76) and current smoking (odds ratio 1.8; 95% confidence interval 1.09-2.79) were statistically significant risk factors for 50-100% internal carotid artery stenosis.ConclusionThe prevalence of internal carotid artery stenosis seems to be lower in patients with recent transient ischaemic attack or ischaemic stroke than stated in previous studies. We found that higher age, male sex, White ethnicity, retinal ischaemia and current smoking were important risk factors for symptomatic internal carotid artery stenosis.

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Project description:IntroductionHand grip strength (HGS) is an important measure in a physiotherapy assessment and for this purpose it is necessary to have valid and reliable instruments to measure it. In this study we aimed at investigating the reliability, validity, and agreement of the new hand-held dynamometer NOD (OT-Bioelettronica, To-Italy) compared to Jamar® hydraulic dynamometer (JD), the gold standard.MethodsFifty healthy subjects were selected; 9 trials for the dominant hand and 9 trials for the non-dominant hand were administrated to each of them: 3 trials of HGS with the JD in rung #3, 3 trials with the JD-adapted-grip (like the NOD one), and 3 trials with NOD. To verify the reliability of NOD, the Intraclass Correlation Coefficient (ICC 3,1) was calculated with a mixed effects model with the addition of adjustment variables (age, gender, dominant / non-dominant limb, trials). The model used single HGS measurements to estimate variance components, so reflecting both degree of correspondence and agreement among devices. To assess concurrent validity NOD was compared to the "gold standard" JD, in terms of ICCs and through Pearson correlation. The agreement between the methods of measurement was calculated with the Limits of Agreement (LoA) and the plots of Bland-Altman.ResultsAll ICCs show high inter-reliability; the results are very similar for both dynamometers. The value of the adjusted ICC of NOD was 0.90. For validity, Pearson correlations of NOD towards JD and JD-adapted-grip were high (r = 0.87 and 0.88). However, the LoA and the plots of Bland-Altman demonstrated that there is no agreement between NOD and JD and between NOD and JD-adapted-grip, with NOD showing lower mean scores than JD.ConclusionsNOD is a reliable and valid instrument for HGS. However, even if it cannot be considered interchangeable with JD because there is no agreement between them in free-living adults, NOD is easier to carry than other dynamometers, it has a Bluetooth® connection with a free App and it is a multi-purpose tool that should be considered both in daily practice and in clinical settings.

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Dataset Information

Reliability and agreement of point-of-care carotid artery examinations by experts using hand-held ultrasound devices in patients with ischaemic stroke or transitory ischaemic attack.

Publications

Reliability and agreement of point-of-care carotid artery examinations by experts using hand-held ultrasound devices in patients with ischaemic stroke or transitory ischaemic attack.

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