Interrater Reliability of Point-of-Care Cardiopulmonary Ultrasound in Patients With Septic Shock: An Analysis of Agreement Between Treating Clinician and Expert Reviewers

Schnittke, Nikolai; Schmidt, Jessica; Lin, Amber; Resop, Dana; Neasi, Eric; Damewood, Sara

doi:10.1016/j.jemermed.2022.12.020

Cited by 4 publications

(6 citation statements)

References 33 publications

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“… 3 8 Schnittke et al showed poor interobserver agreement on RV function (kappa −0.05). 21 Taylor and Moore 22 reported higher kappa values among trained physicians compared with residents in the identification of RV strain suggesting that expertise is required to perform the evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…For the current study, recorded TTEs were transferred and stored securely in an anonymous manner according to data management agreement (Central Region Denmark, no. 1-52-81- [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22]. The study applies to the Guidelines for Reporting Reliability and Agreement Studies (GRRAS) recommendations intended for the conduction and reporting of reliability studies.…”

Section: Ethical Considerationsmentioning

confidence: 99%

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Validation of Echocardiographic Measurements in Patients with Pulmonary Embolism in the RIETE Registry

Lyhne,

Bikdeli,

Dudzinski

et al. 2024

TH Open

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Background In acute pulmonary embolism (PE), echocardiographic identification of right ventricular (RV) dysfunction will inform prognostication and clinical decision-making. Registro Informatizado Enfermedad TromboEmbolica (RIETE) is the world's largest registry of patients with objectively confirmed PE. The reliability of site-reported RV echocardiographic measurements is unknown. We aimed to validate site-reported key RV echocardiographic measurements in the RIETE registry. Methods Fifty-one randomly chosen patients in RIETE who had transthoracic echocardiogram (TTE) performed for acute PE were included. TTEs were de-identified and analyzed by a core laboratory of two independent observers blinded to site-reported data. To investigate reliability, intraclass correlation coefficients (ICCs) and Bland–Altman plots between the two observers, and between an average of the two observers and the RIETE site-reported data were obtained. Results Core laboratory interobserver variations were very limited with correlation coefficients >0.8 for all TTE parameters. Agreement was substantial between core laboratory observers and site-reported data for key parameters including tricuspid annular plane systolic excursion (ICC 0.728; 95% confidence interval [CI], 0.594–0.862) and pulmonary arterial systolic pressure (ICC 0.726; 95% CI, 0.601–0.852). Agreement on right-to-left ventricular diameter ratio (ICC 0.739; 95% CI, 0.443–1.000) was validated, although missing data limited the precision of the estimates. Bland–Altman plots showed differences close to zero. Conclusion We showed substantial reliability of key RV site-reported measurements in the RIETE registry. Ascertaining the validity of such data adds confidence and reliability for subsequent investigations.

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Section: Discussionmentioning

confidence: 99%

Section: Ethical Considerationsmentioning

confidence: 99%

Validation of Echocardiographic Measurements in Patients with Pulmonary Embolism in the RIETE Registry

Lyhne,

Bikdeli,

Dudzinski

et al. 2024

TH Open

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“…Most studies show good agreement between novice operator-performed ultrasound and experienced operatorperformed ultrasound. Reported evidence includes findings in echocardiography with good agreement [9] and others with a not-so-good agreement [10,11]. Lung ultrasound is valuable and reproducible [8].…”

Section: Introductionmentioning

confidence: 99%

“…Since the introduction of point-of-care ultrasonography, many studies have evaluated the agreement between POCUS-specific findings compared to comprehensive ultrasonography, which is the ultrasound evaluation performed by radiologists and/or cardiologists as experts in the field. B lines, pleural effusion, dilated heart cavities, valvulopathies, and many other specific alterations have been analyzed [9][10][11][12]. Most studies show good agreement between novice operator-performed ultrasound and experienced operatorperformed ultrasound.…”

Section: Introductionmentioning

confidence: 99%

Agreement of point of care ultrasound and final clinical diagnosis in patients with acute heart failure, acute coronary syndrome, and shock: POCUS not missing the target

Núñez-Ramos,

Duarte-Misol,

Petro

et al. 2024

Intern Emerg Med

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Point-of-care ultrasound (POCUS) is an important tool for clinical diagnosis and decision-making in critical and non-critical scenarios. Dyspnea, chest pain, and shock are conditions susceptible to evaluation with ultrasound considering diagnostic accuracy and clinical impact already proven. There is scarce evidence in diagnosis agreement using ultrasound as an extension of physical examination. We aimed to evaluate ED patients in whom POCUS was performed, to analyze agreement between clinical initial diagnosis using ultrasound images and final diagnosis. Furthermore, we analyze failed diagnosis, inconclusive POCUS exams, and discuss details. A cross-sectional analytical study was conducted on adults who visited the emergency department with any of these three chief complaints: dyspnea, chest pain, and shock. All were evaluated with ultrasound at admission. Agreement between initial diagnosis using POCUS and final definite diagnosis was calculated. Failed diagnosis and inconclusive exams were analyzed. A total of 209 patients were analyzed. Populations: mostly males, mean age 64 years old, hypertensive. Agreement on patients with dyspnea and suspicion of acute decompensated heart failure was 0.98; agreement on chest pain suspicion of non-ST acute coronary syndrome was 0.96; agreement on type of shock was 0.90. Among the population, 12 patients had an inconclusive POCUS exam, and 16 patients had a failed diagnosis. The use of POCUS in the emergency department shows almost perfect agreement when compared with the final diagnosis in individuals experiencing acutely decompensated heart failure, acute coronary syndrome, and shock. Prospective studies are needed to evaluate the impact of this tool on mortality and prognosis when there are diagnostic errors.

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“…Most studies show good agreement between novice operator-performed ultrasound and experienced operator-performed ultrasound. Reported evidence includes ndings in echocardiography with good agreement (9) and others with a not so good agreement (10,11). Lung ultrasound is valuable and reproducible (8).…”

Section: Introductionmentioning

confidence: 99%

Agreement of point of care ultrasound and final clinical diagnosis in patients with acute decompensated heart failure, acute coronary syndrome, and shock: POCUS not missing the target

Ramos,

Misol,

Petro

et al. 2024

Preprint

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Introduction: Point-of-Care ultrasound (POCUS) is an important tool for clinical diagnosis and decision-making in critical and non-critical scenarios. Dyspnea, chest pain and shock are conditions valuable to evaluate with ultrasound considering diagnostic accuracy and clinical impact already proven. There is scarce evidence in diagnosis agreement using ultrasound as an extension of physical examination. We aimed to evaluate ED patients in whom POCUS was performed, to analyze agreement between clinical initial diagnosis using ultrasound images and final diagnosis. Furthermore, we analyze failed diagnosis, inconclusive POCUS exams and discuss details. Methods: A cross-sectional analytical study was conducted in adults who visited the emergency department with any of these three chief complaints: dyspnea, chest pain, shock. All were evaluated with ultrasound at admission. Agreement between initial diagnosis using POCUS and final definite diagnosis was calculated. Failed diagnosis and inconclusive exams were analyzed. Results: A total of 209 patients were analyzed. Populations mostly males, mean age 64yo, hypertensive. Patients with dyspnea, agreement in heart failure diagnosis was 0.98; agreement in chest pain with non-ST acute coronary syndrome was 0.96; agreement in type of shock was 0.90. Twelve 12 (5%) patients had an inconclusive POCUS exam, and 16 (7%) patients had a failed diagnosis. Conclusion: The use POCUS in the emergency department shows almost perfect agreement when compared with the final diagnosis in individuals experiencing acutely decompensated heart failure, acute myocardial infarction, and shock. Prospective studies are needed to evaluate the impact of this tool on mortality and prognosis when there are diagnostic errors.

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Interrater Reliability of Point-of-Care Cardiopulmonary Ultrasound in Patients With Septic Shock: An Analysis of Agreement Between Treating Clinician and Expert Reviewers

Cited by 4 publications

References 33 publications

Validation of Echocardiographic Measurements in Patients with Pulmonary Embolism in the RIETE Registry

Validation of Echocardiographic Measurements in Patients with Pulmonary Embolism in the RIETE Registry

Agreement of point of care ultrasound and final clinical diagnosis in patients with acute heart failure, acute coronary syndrome, and shock: POCUS not missing the target

Agreement of point of care ultrasound and final clinical diagnosis in patients with acute decompensated heart failure, acute coronary syndrome, and shock: POCUS not missing the target

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