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Focused Transthoracic Echocardiography Performed and Interpreted by Medical Residents in the Critically Ill FREE TO VIEW

Jonathan Caronia, DO; Richard Kutnick, MD; Adrian Sarzynski, MD; Georgia Panagopoulos, PhD; Bushra Mina, MD
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Lenox Hill Hospital, New York, NY

Chest. 2011;140(4_MeetingAbstracts):895A. doi:10.1378/chest.1106522
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PURPOSE: Intensivist-performed focused echocardiography (echo) is becoming accepted practice. Whether medical residents can perform and interpret studies that show substantial agreement with standard examinations in the critically ill is unknown.

METHODS: Residents were trained in a validated module lasting 8 hours. They obtained 4 views with 2D and color Doppler evaluating for ejection fraction (EF), pericardial effusion, right ventricular (RV) strain, valvular stenosis and regurgitation and wall motion abnormalities (WMAs). Consecutive medical ICU and intermediate care patients having formal echocardiograms within 12 hours were enrolled. Informed consent was obtained. No clinical decisions were made based on resident studies. Κappa (Κ), sensitivity and specificity were calculated using the formal examination as a reference. Residents were blinded to the cardiologist interpretation.

RESULTS: Seven residents performed 102 studies. Residents demonstrated substantial agreement with cardiologists for EF as normal, decreased or hyperdynamic (Κ=0.67, p<0.001) and pericardial effusion (Κ=0.60, p<0.001, sensitivity 85%, specificity 93%). For diagnosis of left ventricular systolic dysfunction residents demonstrated a sensitivity of 94% and a specificity of 93%, identifying 17 of 18 cases. Residents correctly identified 11 of 13 pericardial effusions and one case of tamponade. Residents showed moderate agreement for aortic stenosis (Κ=0.54, p<0.001, sensitivity 56%, specificity 98%), aortic insufficiency (Κ=0.50, p<0.001, sensitivity 47%, specificity 97%) and mitral regurgitation (Κ =0.51, p<0.001, sensitivity 65%, specificity 90%). Moderate agreement was demonstrated for WMAs (Κ=0.49, p<0.001, sensitivity 71%, specificity 88%). Residents showed fair agreement for RV strain (Κ=0.38, p<0.001, sensitivity 41%, specificity 95%).

CONCLUSIONS: Focused resident echocardiograms demonstrated substantial agreement with standard examinations for ejection fraction and pericardial effusion, moderate agreement for valvulopathy and WMAs and fair agreement for RV strain.

CLINICAL IMPLICATIONS: Focused echocardiography can be taught to residents in the ICU to hasten diagnosis of critical pathologies while awaiting formal echocardiography.

DISCLOSURE: The following authors have nothing to disclose: Jonathan Caronia, Richard Kutnick, Adrian Sarzynski, Georgia Panagopoulos, Bushra Mina

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