The interrater reliability of ultrasound imaging of the inferior vena cava performed by emergency residents

Akkaya, Arif; Yeşilaras, Murat; Aksay, Ersin; Sever, Mustafa; Atilla, Özge Duman

doi:10.1016/j.ajem.2013.07.006

Cited by 52 publications

(47 citation statements)

References 6 publications

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“…This discrepancy is augmented when calculating IVCCI. These findings are consistent with current literature on the topic 8,14,27, 29…”

Section: Discussionsupporting

confidence: 93%

Inferior Vena Cava Measurement with Ultrasound: What Is the Best View and Best Mode?

Finnerty¹,

Panchal²,

Boulger³

et al. 2017

WestJEM

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IntroductionIntravascular volume status is an important clinical consideration in the management of the critically ill. Point-of-care ultrasonography (POCUS) has gained popularity as a non-invasive means of intravascular volume assessment via examination of the inferior vena cava (IVC). However, there are limited data comparing different acquisition techniques for IVC measurement by POCUS. The goal of this evaluation was to determine the reliability of three IVC acquisition techniques for volume assessment: sub-xiphoid transabdominal long axis (LA), transabdominal short axis (SA), and right lateral transabdominal coronal long axis (CLA) (aka “rescue view”).MethodsVolunteers were evaluated by three experienced emergency physician sonographers (EP). Gray scale (B-mode) and motion-mode (M-mode) diameters were measured and IVC collapsibility index (IVCCI) calculated for three anatomic views (LA, SA, CLA). For each IVC measurement, we calculated descriptive statistics, intra-class correlation coefficients (ICC), and two-way univariate analyses of variance.ResultsEPs evaluated 39 volunteers, yielding 351 total US measurements. Measurements of the three views had similar means (LA 1.9 ± 0.4cm; SA 1.9 ± 0.4cm; CLA 2.0 ± 0.5cm). For B-Mode, LA had the highest ICC (0.86, 95% CI [0.76–0.92]) while CLA had the poorest ICC (0.74, 95% CI [0.56–0.85]). ICCs for all M-mode IVCCI were low. Significant interaction effects between anatomical view and EP were observed for B-mode and M-mode measurements. Post-hoc analyses revealed difficulty in consistent view acquisition between EPs.ConclusionInter-rater reliability of the IVC by EPs was highest for B-mode LA and poorest for all M-Mode IVC collapsibility indices (IVCCI). These results suggest that B-mode LA holds the most promise to deliver reliable measures of IVC diameter. Future studies may focus on validation in a clinical setting as well as comparison to a reference standard.

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“…This discrepancy is augmented when calculating IVCCI. These findings are consistent with current literature on the topic 8,14,27, 29…”

Section: Discussionsupporting

confidence: 93%

Inferior Vena Cava Measurement with Ultrasound: What Is the Best View and Best Mode?

Finnerty¹,

Panchal²,

Boulger³

et al. 2017

WestJEM

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“…The interrater reliability was moderate between nurses and physicians, comparable to that of the National Institute of Health stroke scale, the road test after stroke or the ultrasound imaging of the inferior vena cava performed by emergency department residents 9, 10, 11. In contrast, patient self‐rating of severity of sickness was only weakly, but significantly associated with hospitalisation, and severity of pain was not associated with either outcome.…”

Section: Discussionmentioning

confidence: 77%

Clinical intuition ratings are associated with morbidity and hospitalisation

et al. 2015

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SummaryObjectiveTo evaluate how the rating of the severity of sickness – as performed by the physician, nurse and patient – is associated with hospitalisation and acute morbidity.MethodsProspective observational study, performed in the emergency department of a tertiary hospital. Patients, physicians and nurses were interviewed separately after the first contact from 21 October through to 11 November 2013.ResultsOf 2426 presenting patients, 1861 were screened, and 1196 were included. A total of 299 (25%) were hospitalised, 504 (42%) suffered acute morbidity. In the univariate analysis, the physician's, nurse's and patient's rating of severity of sickness, expressed on a scale from 0 to 10, was significantly associated with hospitalisation (physicians: OR 1.61, 95% CI 1.50–1.73; nurses: OR 1.52, 1.41–1.64; patients: OR 1.16, 1.10–1.22), and with acute morbidity (OR 1.49, 1.40–1.59; OR 1.39, 1.30–1.48 and OR 1.05, 1.003–1.09 respectively). The area under the curve of the receiver operating characteristic curves was 0.77, 0.72 and 0.61 for hospitalisation, and 0.72, 0.68 and 0.54 for acute morbidity. The interrater reliability was estimated by the intraclass correlation, which was 0.49 for physician/nurse, 0.17 for nurse/patient and 0.07 for physician/patient. In a multivariable analysis model consisting of age, male sex, ethnic origin, ratings of severity of sickness, symptoms, ability to go home and hospitalisation during the preceding 12 months, only age, and the physician's and nurses' rating of severity of sickness remained significantly associated with both outcomes.ConclusionThe first impression of severity of sickness was associated with hospitalisation and morbidity.

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“…The IVC may be measured at a point which is not the true maximum diameter. IVC measurements have sub-optimal inter-operator reliability (10,11). Translational artifact during inspiration may be incorrectly interpreted as IVC variation (12).…”

Section: ) Multiple Patient and Operator Factors Limit Accurate Measmentioning

confidence: 99%

COUNTERPOINT: Should Acute Fluid Resuscitation Be Guided Primarily by Inferior Vena Cava Ultrasound for Patients in Shock? No

Kory

2017

CHEST

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The interrater reliability of ultrasound imaging of the inferior vena cava performed by emergency residents

Cited by 52 publications

References 6 publications

Inferior Vena Cava Measurement with Ultrasound: What Is the Best View and Best Mode?

Inferior Vena Cava Measurement with Ultrasound: What Is the Best View and Best Mode?

Clinical intuition ratings are associated with morbidity and hospitalisation

COUNTERPOINT: Should Acute Fluid Resuscitation Be Guided Primarily by Inferior Vena Cava Ultrasound for Patients in Shock? No

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