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To assess the correlation between total serum bilirubin (TSB) and transcutaneous bilirubin (TcB) values in Malawian newborn infants, and to investigate whether TcB can be used safely to guide phototherapy treatment in the absence of TSB results.128 newborn jaundiced infants were studied in the neonatal nursery at Queen Elizabeth Central Hospital, Blantyre. Paired TSB and TcB measurements (from forehead and sternum) were compared using the linear regression and Bland-Altman methods. Clinical decisions based on TcB results were compared with those based on 'gold standard' TSB results.For infants not under phototherapy, the lowest TcB reading (from forehead or sternum) gave the strongest correlation with TSB: r = 0·83 for term infants and r = 0·71 for premature infants. For infants undergoing phototherapy, the highest TcB reading gave the strongest correlation with TSB: r = 0·66 for term infants and r = 0·71 for premature infants. TcB values overestimated the degree of jaundice. For infants not under phototherapy, the mean (SD) bias and imprecision of TcB was 25 (72) μmol/L for term infants and 37 (73) μmol/L for premature infants. For infants under phototherapy, the mean bias and imprecision was 30 (79) μmol/L for term infants and 44 (77) μmol/L for premature infants. For infants not under phototherapy, using the lowest TcB reading to guide treatment decisions (n = 167) had good sensitivity (91%) and specificity (90%). For infants undergoing phototherapy, using the highest TcB reading to guide treatment decisions (n = 129) had good sensitivity (94%), but lower specificity (36%).TcB can be used to safely guide phototherapy treatment in a resource-poor setting.

The prevalence of heart failure (HF) is increasing as the population ages, but its rapid diagnosis and phenotype identification remain challenging. We sought to determine whether acoustic cardiography can accurately identify HF and its phenotypes.Three cohorts of patients were studied [94 with hypertension, 109 with HF and normal ejection fraction (HFNEF, EF ≥ 50%) and 89 with HF and reduced ejection fraction (HFREF, EF50%)]. All participants received acoustic cardiography and echocardiography examinations. Acoustic cardiographic parameters included S3 score (probability that the third heart sound exists), electromechanical activation time (EMAT, interval from Q wave to the first heart sound; EMAT/RR is EMAT normalized by heart rate), and systolic dysfunction index (SDI, a combination of EMAT/RR, S3 score, QRS duration and QR interval). Receiver operative characteristic curves were used to determine diagnostic utility of acoustic cardiography.EMAT/RR significantly differentiated HFNEF from hypertension (area under curve [AUC], 0.83; 95% confidence interval [CI], 0.77-0.89) with an EMAT/RR11.54% yielded 55% sensitivity and 90% specificity. Similarly, an echo-measured E/e'15 yielded 55% sensitivity, 90% specificity and 0.84 AUC in detecting HFNEF. Whereas SDI out-performed the other acoustic cardiographic parameters in differentiating HFREF from HFNEF (AUC, 0.81; 95% CI, 0.75-0.87), and an SDI5.43 yielded 53% sensitivity and 91% specificity. The E/e' ratio had a similar diagnostic performance.Our study demonstrates that this bedside technology may be helpful in identifying HF and its phenotypes, especially when echocardiography is not immediately available.

Numerous bedside diagnostic modalities are appropriate for the practice of emergency medicine. The proliferation of sophisticated technology is likely to increase both the availability and accuracy of commercial testing products. If health care reform in the United States results in a relaxation of the CLIA regulations, there will be a rapid expansion of research and development aimed at the biotechnology market. How much this would pertain to hospital-based emergency practice remains to be seen. Cost containment pressures may act in both directions on the utilization of available bedside technology. Although these tests are often less expensive than centralized laboratory determinations, the ready availability of near-patient testing may result in an increase in use that negates the lower cost. As with other diagnostic modalities, a thoughtful, considered approach based on scientific evidence will be necessary to formulate the appropriate use of bedside testing in individual emergency practice settings.

Low left ventricular ejection fraction (LVEF) and the presence of restrictive LV filling pattern are poor prognosticators in heart failure patients with reduced EF (HFREF). We sought to investigate whether acoustic cardiography can identify these high-risk HFREF subgroups.A total of 127 HFREF patients (EF50%) were enrolled into our study. All patients underwent acoustic cardiographic and echocardiographic examinations. Acoustic cardiographic parameters included S3 score (probability that the third heart sound exists), electromechanical activation time (EMAT, interval from Q wave to the first heart sound; %EMAT is the proportion of cardiac cycle that EMAT occupies), and systolic dysfunction index (SDI, a derived variable from the combination of %EMAT, S3 score, QRS duration and QR interval). Receiver operating characteristic curves were used to determine diagnostic utility of acoustic cardiography.SDI discriminated (area under curve [AUC], 0.79; 95% confidence interval [CI], 0.71-0.87) patients with severely impaired EF (EF ≤ 35%) from those with moderately impaired EF (35%EF50%) with an SDI5 that yielded 87% sensitivity and 60% specificity. An S3 score4 identified patients with restrictive LV filling pattern with 0.76 AUC (95% CI, 0.67-0.84), 81% sensitivity and 55% specificity.SDI and S3 score obtained by acoustic cardiography identified HFREF patients with severely impaired systolic and diastolic function, respectively. This simple, bedside technology may be used as a screening tool to identify the sickest HFREF patients for more intensive therapy.