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

• Published in: Academic emergency medicine Vol. 24; no. 7; pp. 867 - 874
• Main Authors: Rutz, Matt A., Clary, Julie M., Kline, Jeffrey A., Russell, Frances M., Mark Courtney, D.
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01-07-2017
• Subjects: Academic Medical Centers - statistics & numerical data; Acute Disease; Aged; Aged, 80 and over; Cardiology; Cardiology - statistics & numerical data; Dyspnea; Dyspnea - etiology; Echocardiography; Emergency medical care; Emergency Medicine - statistics & numerical data; Emergency Service, Hospital - statistics & numerical data; Female; Humans; Hypertrophy, Right Ventricular - complications; Hypertrophy, Right Ventricular - diagnostic imaging; Male; Middle Aged; Physicians; Point-of-Care Testing; Prospective Studies; Reproducibility of Results; Ultrasonic imaging; Ventricular Dysfunction, Right - diagnosis
• DOI: 10.1111/acem.13210
• EISSN: 1553-2712
• ISSN: 1069-6563

Objective
Focused cardiac ultrasound (FOCUS) is a useful tool in evaluating patients presenting to the emergency department (ED) with acute dyspnea. Prior work has shown that right ventricular (RV) dilation is associated with repeat hospitalizations and shorter life expectancy. Traditionally, RV assessment has been evaluated by cardiologist‐interpreted comprehensive echocardiography. The primary goal of this study was to determine the inter‐rater reliability between emergency physicians (EPs) and a cardiologist for determining RV dilation on FOCUS performed on ED patients with acute dyspnea.
Methods
This was a prospective, observational study at two urban academic EDs; patients were enrolled if they had acute dyspnea and a computed tomographic pulmonary angiogram without acute disease. All patients had an EP‐performed FOCUS to assess for RV dilation. RV dilation was defined as an RV to left ventricular ratio greater than 1. FOCUS interpretations were compared to a blinded cardiologist FOCUS interpretation using agreement and kappa statistics.
Results
Of 84 FOCUS examinations performed on 83 patients, 17% had RV dilation. Agreement and kappa, for EP‐performed FOCUS for RV dilation were 89% (95% confidence interval [CI] 80–95%) and 0.68 (95% CI 0.48–0.88), respectively.
Conclusions
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.