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

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

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)867-874
Number of pages8
JournalAcademic Emergency Medicine
Volume24
Issue number7
DOIs
StatePublished - Jul 1 2017

Fingerprint

Cardiology
Dilatation
Emergencies
Physicians
Dyspnea
Hospital Emergency Service
Confidence Intervals
Acute Disease
Life Expectancy
Observational Studies
Echocardiography
Angiography
Hospitalization
Prospective Studies
Lung
Cardiologists

ASJC Scopus subject areas

  • Emergency Medicine

Cite this

Emergency Physicians Are Able to Detect Right Ventricular Dilation With Good Agreement Compared to Cardiology. / Rutz, Matt A.; Clary, Julie M.; Kline, Jeffrey; Russell, Frances.

In: Academic Emergency Medicine, Vol. 24, No. 7, 01.07.2017, p. 867-874.

Research output: Contribution to journalArticle

@article{3dcb6d898c8b47c085c8e219a3e2b0b9,
title = "Emergency Physicians Are Able to Detect Right Ventricular Dilation With Good Agreement Compared to Cardiology",
abstract = "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.",
author = "Rutz, {Matt A.} and Clary, {Julie M.} and Jeffrey Kline and Frances Russell",
year = "2017",
month = "7",
day = "1",
doi = "10.1111/acem.13210",
language = "English (US)",
volume = "24",
pages = "867--874",
journal = "Academic Emergency Medicine",
issn = "1069-6563",
publisher = "Wiley-Blackwell",
number = "7",

}

TY - JOUR

T1 - Emergency Physicians Are Able to Detect Right Ventricular Dilation With Good Agreement Compared to Cardiology

AU - Rutz, Matt A.

AU - Clary, Julie M.

AU - Kline, Jeffrey

AU - Russell, Frances

PY - 2017/7/1

Y1 - 2017/7/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85020398681&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85020398681&partnerID=8YFLogxK

U2 - 10.1111/acem.13210

DO - 10.1111/acem.13210

M3 - Article

VL - 24

SP - 867

EP - 874

JO - Academic Emergency Medicine

JF - Academic Emergency Medicine

SN - 1069-6563

IS - 7

ER -