Comparison of Emergency Echocardiographic Results between Cardiologists and an Emergency Medicine Resident in Acute Coronary Syndrome
Archives of Academic Emergency Medicine,
Vol. 9 No. 1 (2021),
1 January 2021
,
Page e53
https://doi.org/10.22037/aaem.v9i1.1247
Abstract
Introduction: Early detection of regional wall motion abnormality (RWMA) can be a reliable tool for rapid disposition of patients with acute coronary syndrome (ACS) in the emergency department. In this study, the diagnostic accuracy of point-of-care echocardiography performed by a trained emergency medicine resident was evaluated in comparison with board-certified cardiologists.
Methods: A prospective, cross-sectional study was implemented on adult patients with ACS. A trained emergency medicine (EM) PGY-3 resident performed point-of-care echocardiography under the supervision of two cardiologists and the reports were compared with cardiologists as a reference test.
Results: 100 patients with the mean age of 54.1 ± 11.5 years were recruited (65% male). Based on Thrombolysis in Myocardial Infarction (TIMI) and History, EKG, Age, Risk factors, and troponin (HEART) scores, 43.0% and 25.0% of patients were categorized as low-risk for ACS, respectively. The absolute measure of agreement between cardiologists to determine ejection fraction (EF) was 0.829 (95% CI: 0.74-0.89) based on intraclass correlation coefficient (ICC) estimation. The measurements of agreement between specialists and the EM resident based on the analysis of Kappa coefficient were 0.677 and 0.884 for RWMA and pericardial effusion, respectively. Moreover, 25 patients were in the-low risk group according to the HEART score with an agreement rate of 92% for the lack of RWMA between the EM resident and cardiologists.
Conclusion: This study found acceptable agreement between the EM resident and cardiologists in assessing RWMA in different ACS risk groups. In addition, there was acceptable agreement between the EM resident and cardiologists in determining left ventricular ejection fraction (LVEF) and pericardial effusion.
- Emergency medicine
- Cardiologists
- Patient Discharge
- Ultrasonography
- Point-of-Care Systems
How to Cite
References
Frederiksen CA, Juhl-Olsen P, Andersen NH, Sloth E. Assessment of cardiac pathology by point-of-care ultrasonography performed by a novice examiner is comparable to the gold standard. Scandinavian journal of trauma, resuscitation and emergency medicine. 2013;21(1):87.
Rutz MA, Clary JM, Kline JA, Russell FM. Emergency physicians are able to detect right ventricular dilation with good agreement compared to cardiology. Academic Emergency Medicine. 2017;24(7):867-74.
Labovitz AJ, Noble VE, Bierig M, Goldstein SA, Jones R, Kort S, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. Journal of the American Society of Echocardiography. 2010;23(12):1225-30.
Randazzo MR, Snoey ER, Levitt MA, Binder K. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Academic Emergency Medicine. 2003;10(9):973-7.
Nelson BP, Sanghvi A. Point-of-care cardiac ultrasound: feasibility of performance by noncardiologists. Global heart. 2013;8(4):293-7.
T Arntfield R, J Millington S. Point of care cardiac ultrasound applications in the emergency department and intensive care unit-a review. Current cardiology reviews. 2012;8(2):98-108.
Platz E, Solomon SD. Point-of-care echocardiography in the accountable care organization era. Circulation: Cardiovascular Imaging. 2012;5(5):676-82.
Sechtem U, Achenbach S, Friedrich M, Wackers F, Zamorano JL. Non-invasive imaging in acute chest pain syndromes. European Heart Journal–Cardiovascular Imaging. 2012;13(1):69-78.
Yang E-s, Yeo W, Ko J-I, Kwon J, Choi S-m, Chung J, et al. Video clip training improved emergency medicine residents’ interpretation ability of visual ejection fraction. Hong Kong Journal of Emergency Medicine. 2020;27(1):15-23.
Monsomboon A, Patarateeranon T, Tongyoo S, Surabenjawong U, Chaisirin W, Chakorn T, et al. Agreement between Emergency Physicians and a Cardiologist on Cardiac Function Evaluation after Short Training. Siriraj Medical Journal. 2019;71(4):253-60.
Bustam A, Azhar MN, Veriah RS, Arumugam K, Loch A. Performance of emergency physicians in point-of-care echocardiography following limited training. Emergency Medicine Journal. 2014;31(5):369-73.
Moore CL, Rose GA, Tayal VS, Sullivan DM, Arrowood JA, Kline JA. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Academic Emergency Medicine. 2002;9(3):186-93.
Farsi D, Hajsadeghi S, Hajighanbari MJ, Mofidi M, Hafezimoghadam P, Rezai M, et al. Focused cardiac ultrasound (FOCUS) by emergency medicine residents in patients with suspected cardiovascular diseases. Journal of Ultrasound. 2017;20(2):133-8.
Vignon P, Dugard A, Abraham J, Belcour D, Gondran G, Pepino F, et al. Focused training for goal-oriented hand-held echocardiography performed by noncardiologist residents in the intensive care unit. Intensive care medicine. 2007;33(10):1795-9.
Chisholm CB, Dodge WR, Balise RR, Williams SR, Gharahbaghian L, Beraud A-S. Focused cardiac ultrasound training: how much is enough? The Journal of emergency medicine. 2013;44(4):818-22.
Kerwin C, Tommaso L, Kulstad E. A brief training module improves recognition of echocardiographic wall-motion abnormalities by emergency medicine physicians. Emergency medicine international. 2011;2011.
Henry J, Haji D. Expanding our FoCUS: the utility of advanced echocardiography in the emergency department. Australasian Journal of Ultrasound in Medicine. 2019;22(1):6-11.
Melamed R, Sprenkle MD, Ulstad VK, Herzog CA, Leatherman JW. Assessment of left ventricular function by intensivists using hand-held echocardiography. Chest. 2009;135(6):1416-20.
Pershad J, Myers S, Plouman C, Rosson C, Elam K, Wan J, et al. Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill patient. Pediatrics. 2004;114(6):e667-e71.
Jacob M, Shokoohi H, Moideen F, Pousson A, Boniface K. An Echocardiography Training Program for Improving the Left Ventricular Function Interpretation in Emergency Department; a Brief Report. Emergency. 2017;5(1).
Mandavia DP, Hoffner RJ, Mahaney K, Henderson SO. Bedside echocardiography by emergency physicians. Annals of emergency medicine. 2001;38(4):377-82.
- Abstract Viewed: 1440 times
- pdf Downloaded: 552 times
