Ability of emergency physicians with advanced echocardiographic experience at a single center to identify complex echocardiographic abnormalities

Srikar Adhikari, Albert Fiorello, Lori Stolz, Travis Jones, Richard Amini, Austin Gross, Kathleen O'Brien, Jarrod Mosier, Michael Blaivas
American Journal of Emergency Medicine 2014, 32 (4): 363-6

OBJECTIVES: To determine the ability of emergency physicians to detect complex abnormalities on point-of-care (POC) echocardiograms.

METHODS: Single-blinded, nonrandomized, cross-sectional study. Twenty-five different emergency medicine clinical scenarios (video clips and digital images) covering a variety of echocardiographic abnormalities were presented to a group of emergency physician sonologists. The echocardiographic abnormalities included right ventricular dysfunction, left ventricular systolic dysfunction, diastolic dysfunction, regional wall motion abnormalities, Doppler abnormalities of pericardial tamponade physiology, left ventricular hypertrophy, hypertrophic cardiomyopathy, and aortic abnormalities. All emergency physician sonologists were blinded to the study hypothesis. They reviewed echocardiography video clips and images individually, and their interpretations were compared with the criterion standard (expert echocardiographer interpretations).

RESULTS: A total of 200 echocardiography studies (video clips and images) were independently reviewed by 8 emergency physician sonologists with varying POC echocardiography experiences. Emergency physicians accurately identified left ventricular systolic dysfunction 94% of the time, diastolic dysfunction (100%), and right ventricular dysfunction 80% of the time. Regional wall motion abnormalities were detected only 50% of the time. Doppler echocardiographic abnormalities of pericardial tamponade physiology were accurately identified 57% of the time. Emergency physicians who performed more than 250 POC echocardiograms were found to be more accurate in identifying complex echocardiographic abnormalities.

CONCLUSIONS: Our study results suggest that with increased experience, emergency physicians can accurately identify most of complex echocardiographic abnormalities.

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