Agreement between Emergency Physicians and a Cardiologist on Cardiac Function Evaluation after Short Training

Abstract

Objective: Delayed diagnosis and treatment of shock patients may lead to multiorgan dysfunction syndrome and death. Volume status assessment in shock patients is crucial for guiding early management. Focused echocardiography has become an important tool for assessing volume status because it is non-invasive and easy to perform. We aimed to ascertain the degree of agreement between emergency medicine (EM) residents and a cardiologist on cardiac function evaluations using echocardiography. We also assessed the extent of agreement on pericardial effusion diagnoses. Methods: A cross sectional study was conducted at the Emergency Department, Siriraj Hospital. The EM residents who had limited experience in ultrasound examination underwent a 3-hour echocardiography training course consisting of a lecture and a workshop before starting the study. Patients with shock or suspected hypervolemia were included. Echocardiography was performed by EM residents to evaluate ventricular function of each patients. With visual estimation, they classified the left ventricular function (LVF) into 3 categories: good, moderate and poor. The video files were recorded and re-evaluated by a cardiologist offline. The correlation of left ventricular function estimation and the diagnosis of pericardial effusion between the two operators were determined. Results: Ninety-two patients were enrolled between October and December 2014. The overall agreement of ventricular function assessment between the EM residents and the cardiologist was 79.4% (weighted kappa = 0.73). The degree of agreements of LVF classified as poor, moderate and good LVF were 87.5%, 37.5% and 95% respectively. Moreover, the residents diagnosed the pericardial effusion with 100% accuracy, compared to the cardiologist. Conclusion: Following a short educational training, the EM residents efficiently assessed the left ventricular function with a high level of agreement with a cardiologist.

Assessing left ventricular systolic function by emergency physician using point of care echocardiography compared to expert: systematic review and meta-analysis

“…Thirteen studies that did not meet the inclusion criteria were excluded. Consequently, 12 studies [22][23][24][25][26][27][28][29][30][31][32][33]…”

“…independently extracted data using a standardised form (Table 2). The revised Quality Assessment Tool for Diagnostic Accuracy Studies-2 (QUADAS-2) was used to evaluate the overall quality of the included studies [22][23][24][25][26][27][28][29][30][31][32][33]. The tool was applied by the two reviewers independently, and disagreements were resolved by a third reviewer (T.H.).…”

“…All studies excluded a proportion of their acquired POC echocardiography data, most commonly as a consequence of poor image quality and were consequently considered high risk (total enrolled sample 1309 patients and analysis sample 1131 patients). Eleven were rated as high risk of bias in patient selection due to convenience sampling or due to exclusion criteria, or both (body habitus or technical difficulties obtaining images) [22][23][24][25][26][27][28][29][30]32,33]. The protocol for the POC echocardiography performed by clinician sonographers varied widely between the studies with differing windows, machines, and transducer frequencies.…”

“…The protocol for the POC echocardiography performed by clinician sonographers varied widely between the studies with differing windows, machines, and transducer frequencies. Seven studies included low numbers of clinician sonographers selected from a larger clinician group with unclear reasons for clinician sonographer selection [22,23,26,28,29,32,33].…”

“…In seven studies (688 patients, 786 scans, >119 clinician sonographers; 60 attendings, and 59 emergency medicine residents/fellows) [22,23,25,27,29,31,32], clinician sonographers used the visual estimation method to assess LVSF and reported adequate data to conduct the meta-analyses.…”