Abstract
Background
Pulmonary embolism (PE) is a common emergency department (ED) diagnosis with a wide
range in mortality rates. Methods to identify and risk-stratify PE, including measuring
right ventricular strain (RVS) by echocardiography (echo), are essential in providing
effective and efficient care. A limited echo examination aims to expedite and increase
availability of RVS determination through assessment at the bedside by the ED provider.
Objective
The objective is to determine the level of agreement and test characteristics of right
ventricular dilation (RVd), as a marker of RVS, on limited echo compared with consultative
echo.
Methods
This is a retrospective cohort study of consecutive ED patients undergoing limited
echo examinations for chest pain, dyspnea, or hypotension and a subsequent consultative
echo within 72 hours. κ values and test characteristics were calculated to determine the level of agreement
and accuracy between the limited echo examination and consultative echo for RVd and
RVS.
Results
There were 411 focused examinations performed by 69 different providers over a 12-month
period (median, 5 examinations per provider). The prevalence of RVS on limited echo
examination was 6.2% (n = 25). The κ value for the level of agreement between limited and consultative echo for RVd was
0.44 (95% confidence intervals [CI], 0.27-0.61). The specificity of RVd on limited
echo for RVS was 0.98 (95% CI, 0.96-0.99) with 6 false-positive categorizations, whereas
the sensitivity was 0.26 (95% CI, 0.16-0.37).
Conclusions
In this retrospective cohort study, limited echo demonstrated moderate agreement with
consultative echo for RVd. Right ventricular dilation on limited echo was highly specific
for RVS but had low sensitivity.
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Article Info
Publication History
Published online: December 30, 2013
Accepted:
December 19,
2013
Received:
November 7,
2013
Footnotes
☆Prior Presentations: None.
☆☆Funding Sources/Disclosures: None.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
