Transthoracic echocardiography performed at the patient's bedside by the emergency physician versus the cardiologist: A concordance study about 44 cases

Introduction: Transthoracic echocardiography (TTE) is practised in emergency departments by emergency physicians at the patient’s bedside as a routine special investigation procedure following a detailed physical... [ view full abstract ]

Introduction: Transthoracic echocardiography (TTE) is practised in emergency departments by emergency physicians at the patient’s bedside as a routine special investigation procedure following a detailed physical examination. The purpose of our study is to evaluate the performance of TTE in emergency departments by emergency physicians by comparing the finding obtained to those given by an echoDoppler proficient cardiologist.
Material and methods: This randomised prospective study was carried out in the emergency department during three months inclusive. It included all patients aged > 16 years in whom there was an urgent need to practice a TTE. The patients in the study had to undergo a double echocardiographic examination: an initial echocardiographic investigation carried out by an emergency physician who had previously received a three-month training in Doppler echocardiography, followed by a subsequent investigation performed by an echo-Doppler proficient cardiologist.
The concordance of the findings obtained by both readers was evaluated by Kappa concordance test. The evaluation considered the global visual estimation of the left ventricular ejection fraction (LVEF), the presence or absence of pericardial effusion (independently of the site), and the diameter and compliance of the inferior vena cava (IVC).
Results: Forty-four patients were involved in the study. Mean age was 52 + 13 years, sex ratio 5 males/7 females.
The concordance of the findings obtained by the emergency physician and the cardiologist for the visual estimation of the LVEF was Kappa = 0.82 [95% IC 0.63-1] with an agreement = 0.90 [95% IC 0.74-0.99].
The concordance for measurement of the diameter of the IVC was Kappa = 0.95 [95% IC 0.63-1] with an agreement = 0.95 [95 % IC 0.64-0.99] and for assessment of its compliance it was Kappa=1 with an agreement = 1.
The concordance of the findings obtained for the diagnosis of pericardial effusion was Kappa=0.86 [95% IC 0.71-1] with an agreement = 0.92 [95% IC 0.64-0.99] and the concordance for the detection of echocardiographic signs of compressive effusion was Kappa = 1 with an agreement =1.

Conclusion: The concordance of the findings obtained by both operators was excellent. Emergency physicians should then be encouraged to practise TTE at the patient’s bedside. A prior training of 3 months in Doppler echocardiography is nevertheless necessary.

Key words: Transthoracic echocardiography -emergency physician -cardiologist