Emergency Physicians Are Able to Detect Right Ventricular Dilation With Good Agreement Compared to Cardiology

Rutz, Matt A; Clary, Julie M.; Kline, Jeffrey A.; Russell, Frances M.

doi:10.1111/acem.13210

Cited by 7 publications

(7 citation statements)

References 41 publications

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“…Namely, being able to visualize the main organ affected in AHF to assess severity of presentation has clear face validity. Moreover, POCecho measures including TAPSE have been used with reliability and utility by EPs for risk stratification of other conditions like pulmonary embolism (PE) 47,48,50 . Nevertheless, prior literature on the appropriate use of POC ultrasound in AHF for ED patients is highly limited to diagnosis and assessment of volume status 65 but not risk prediction.…”

Section: Discussionmentioning

confidence: 99%

“…Moreover, POCecho measures including TAPSE have been used with reliability and utility by EPs for risk stratification of other conditions like pulmonary embolism (PE). 47 , 48 , 50 Nevertheless, prior literature on the appropriate use of POC ultrasound in AHF for ED patients is highly limited to diagnosis and assessment of volume status 65 but not risk prediction. LUS, but not POCecho, has also been described for the latter purpose including the recent BLUSHED‐AHF trial 66 and the previous publication from REED‐AHF.…”

Section: Discussionmentioning

confidence: 99%

“… 37 , 42 , 43 , 44 , 45 , 46 Conversely, there is a stark absence of prior ED risk stratification studies that incorporate or consider echocardiography measures. Nevertheless, TAPSE 17 , 38 , 47 , 48 , 49 and other right heart measures 38 , 50 have been used by EPs with high interobserver reliability in the risk stratification of pulmonary embolus, suggesting feasibility for AHF risk stratification.…”

Section: Introductionmentioning

confidence: 99%

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Point‐of‐care echocardiography of the right heart improves acute heart failure risk stratification for low‐risk patients: The REED‐AHF prospective study

Harrison

Favot

Gowland

et al. 2022

Academic Emergency Medicine

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Objectives: Validated acute heart failure (AHF) clinical decision instruments (CDI) insufficiently identify low-risk patients meriting consideration of outpatient treatment.While pilot data show that tricuspid annulus plane systolic excursion (TAPSE) is associated with adverse events, no AHF CDI currently incorporates point-of-care echocardiography (POCecho). We evaluated whether TAPSE adds incremental risk stratification value to an existing CDI. Methods:Prospectively enrolled patients at two urban-academic EDs had POCechos obtained before or <1 h after first intravenous diuresis, positive pressure ventilation, and/or nitroglycerin. STEMI and cardiogenic shock were excluded. AHF diagnosis was adjudicated by double-blind expert review. TAPSE, with an a priori cutoff of ≥17 mm, was our primary measure. Secondary measures included eight additional right heart and six left heart POCecho parameters. STRATIFY is a validated CDI predicting 30-day death/cardiopulmonary resuscitation, mechanical cardiac support, intubation, new/ emergent dialysis, and acute myocardial infarction or coronary revascularization in ED AHF patients. Full (STRATIFY + POCecho variable) and reduced (STRATIFY alone) logistic regression models were fit to calculate adjusted odds ratios (aOR), categoryfree net reclassification index (NRI cont ), ΔSensitivity (NRI events ), and ΔSpecificity (NRI nonevents ). Random forest assessed variable importance. To benchmark risk prediction to standard of care, ΔSensitivity and ΔSpecificity were evaluated at risk thresholds more conservative/lower than the actual outcome rate in discharged patients.Results: A total of 84/120 enrolled patients met inclusion and diagnostic adjudication criteria. Nineteen percent experiencing the primary outcome had higher STRATIFY scores compared to those event free (233 vs. 212, p = 0.009

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Point‐of‐care echocardiography of the right heart improves acute heart failure risk stratification for low‐risk patients: The REED‐AHF prospective study

Harrison

Favot

Gowland

et al. 2022

Academic Emergency Medicine

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“…That is to say nothing of the considerable technical and procedural diagnostic skills the emergency physician develops over the course of her career. The literature abounds with studies gauging accuracy and diagnostic skill across every body system from detection of ectopic pregnancy 6 to right ventricular dilation and dysfunction 7 to acute stroke/transient ischaemic attack 8 . Not only must the generalist emergency physician demonstrate expert clinical and diagnostic acumen but she must do so against the ‘gold standard’ sub‐specialist.…”

Section: Competing Interestsmentioning

confidence: 99%

Emergency physicians are excellent pattern recognisers: No

Dwyer

2020

Emerg Medicine Australasia

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“…[1][2][3][4][5][6][7] The accuracy of cardiac POCUS by emergency physicians has been demonstrated in previous investigations with respect to evaluation for cardiac standstill, pericardial effusion, left ventricular systolic dysfunction, and vascular filling. 2,3,5,6,8,9 In the pediatric population the literature is less robust. Cardiac POCUS has been shown to be a helpful tool to diagnose acute pathology and assess for cardiac dysfunction in the pediatric emergency department (ED), but studies have been limited to single or expert sonologists, making them less generalizable.…”

mentioning

confidence: 99%

Use of Cardiac Point-of-Care Ultrasound in the Pediatric Emergency Department

et al. 2020

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Objectives: We sought to describe the test characteristics of cardiac point-of-care ultrasound (POCUS) performed by pediatric emergency medicine (PEM) physicians after structured cardiac POCUS training. Methods: We evaluated the use of clinically indicated cardiac POCUS by PEM physicians in a single tertiary care pediatric emergency department after implementation of a focused cardiac POCUS training curriculum. The test characteristics of the sonologist interpretation were compared with expert POCUS review, by PEM physicians who have completed PEM POCUS fellowship training, for the assessment of both pericardial effusion and left ventricular systolic dysfunction.Results: A total of 1241 cardiac POCUS examinations were performed between July 2015 and December 2017, of which 456 were clinically indicated and underwent expert POCUS review and comprised the study sample. These examinations were performed by 33 different PEM attending sonologists. Chest pain (52%), dyspnea (20%), and tachycardia (18%) were the most common indications for cardiac POCUS. Prevalence of pericardial effusion and global systolic dysfunction based on expert POCUS review were 11% (48/443) and 4% (16/435), respectively. Real-time cardiac POCUS interpretation had a sensitivity and specificity of 100% and 99.5%, respectively, for both pericardial effusion and left ventricular systolic dysfunction when compared with expert POCUS review.Conclusions: Cardiac POCUS is both sensitive and specific for identifying pericardial effusion and left ventricular systolic dysfunction when performed by PEM attendings with focused training.

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Emergency Physicians Are Able to Detect Right Ventricular Dilation With Good Agreement Compared to Cardiology

Abstract: Emergency physician sonographers are able to detect RV dilation with good agreement when compared to cardiology. These results support the wider use of EP-performed FOCUS to evaluate for RV dilation in ED patients with dyspnea.

Cited by 7 publications

References 41 publications

Point‐of‐care echocardiography of the right heart improves acute heart failure risk stratification for low‐risk patients: The REED‐AHF prospective study

Point‐of‐care echocardiography of the right heart improves acute heart failure risk stratification for low‐risk patients: The REED‐AHF prospective study

Emergency physicians are excellent pattern recognisers: No

Use of Cardiac Point-of-Care Ultrasound in the Pediatric Emergency Department

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