Journal of Ultrasound

, Volume 20, Issue 2, pp 133–138 | Cite as

Focused cardiac ultrasound (FOCUS) by emergency medicine residents in patients with suspected cardiovascular diseases

  • Davood Farsi
  • Skokoufeh Hajsadeghi
  • Mohammad Javad Hajighanbari
  • Mani Mofidi
  • Peyman Hafezimoghadam
  • Mahdi Rezai
  • Babak Mahshidfar
  • Samaneh Abiri
  • Saeed Abbasi
Original Article



Few studies have assessed the value and accuracy of focused cardiac ultrasound (FOCUS) performed by emergency physicians. The aim of the present study was to evaluate the diagnostic accuracy of FOCUS performed by emergency medicine residents compared to echocardiography performed by a cardiologist in emergency department (ED) patients suspected of cardiovascular disease.


The research involved a prospective observational cross-sectional study enrolling patients over 18-years old suspected of having cardiovascular disease who required an echocardiograph. For each patient, a FOCUS test was conducted by a trained emergency medicine resident. The diagnostic accuracy of ED performed FOCUS was compared to echocardiography performed by a cardiologist (gold standard) in the ED. Sensitivity, specificity, positive and negative predictive values, and likelihood ratios were calculated for FOCUS. The agreement of EM residents and cardiologists on each finding was evaluated using Cohen’s kappa coefficient with 95% CI.


Two hundred and five patients, with a mean age of 61.0 ± 17 years (50% male), were included in this study. Agreement between FOCUS performed by an emergency medicine resident and echocardiography performed by a cardiologist in measuring ejection fraction of the left ventricle was 91% (κ = 0.85; 95% CI = 0.79–0.91). Reports of the two groups for identifying right ventricular enlargement showed 96% agreement (κ = 0.86; 95% CI = 0.82–0.90). The agreements for right ventricular pressure overload, wall motion abnormality and pericardial effusion were 100% (κ = 0.83; 95% CI = 0.77–0.89), 92% (κ = 0.83; 95% CI = 0.76–0.90), and 96% (κ = 0.83; 95% CI = 0.77–0.89), respectively.


FOCUS performed by emergency medicine residents is comparable to echocardiography performed by cardiologists. Therefore, it could be a reliable tool and screening test for initial testing of patients suspected of cardiac abnormalities.


Ultrasonography Diagnostic test approval Diagnostic techniques Cardiovascular Cardiac tamponade Pericardial effusion 



Pochi studi hanno valutato il valore e l’accuratezza dell’ecocardiografia eseguita da medici dell’emergenza (focused cardiac ultrasound, FOCUS). Lo scopo del presente studio è di valutare l’accuratezza diagnostica della FOCUS eseguita da medici dell’Emergenza confrontata con l’ecocardiografia eseguita da cardiologi nel Dipartimento di Emergenza in pazienti con sospetta malattia cardiovascolare.


Si tratta di uno studio osservazionale, prospettico, cross-sectional che ha arruolato pazienti sopra i 18 anni con sospetta malattia cardiovascolare in cui era indicata un’ecocardiografia. L’accuratezza diagnostica della FOCUS eseguita dal medico dell’Emergenza è stata confrontata con l’ecocardiografia eseguita dal cardiologo nel Dipartimento di Emergenza (gold standard). Sono stati calcolati per l’ecografia FOCUS la sensibilità, la specificità, i valori predittivi positivo e negativo e il grado di confidenza. La concordanza del medico dell’Emergenza con il cardiologo per ogni parametro sono stati valutati con l’indice K di Cohen con il 95% di Indice di Confidenza.


Sono stati inclusi nello studio 205 pazienti con età media di 61,0 ± 17 anni (50% maschi). La concordanza tra il medico dell’Emergenza ed il cardiologo nella misurazione della frazione di eiezione del ventricolo sinistro è stata del 91% (k = 0,85; 95%CI = 0,79-0,91). I referti dei due specialisti nell’identificare dilatazione del ventricolo destro hanno mostrato un 96% di concordanza (k = 0,86;95% CI = 0,82-0,90). La concordanza per il sovraccarico pressorio del ventricolo destro, le anormalità del movimento di parete ed il versamento pericardico è stata del 100% (k = 0,83; 95% CI = 0,77-0,89), 92% 8 k = 0,83; 95% CI = 0,76-0,90), e 96% (k = 0,83;95% CI = 0,77-0,89) rispettivamente.


FOCUS eseguita da medici dell’Emergenza è comparabile a quella eseguita dai cardiologi. Quindi può essere considerata un mezzo affidabile ed un test di screening per l’iniziale valutazione dei pazienti con sospetta patologia cardiaca.


Compliance with ethical standards

Conflict of interest

The authors declare they do not have any financial or other conflicts-of-interest related to the submission.

Ethical approval

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2000.

Informed consent

All patients provided written informed consent to enrolment in the study and to the inclusion in this article of information that could potentially lead to their identification.

Author contributions

D.F, S.A, S.H and M.R: Idea, Designed the study. MJ.H, Sa.A and P.H: Registering the study in research center of IUMS, Communicating with the manager of hospitals and arrangement of implementation. D.F, S.A, S.H, M.M and MJ.H: Data collection (visiting the patients, ultrasonography). B.M, Sa.A: Quality control. B.M, M.R, M.M and S.A: Writing the article (search, data bank, primary manuscript). M.R, D.F, and S.A: Analysis by SPSS and Finalizing the article. S.A: takes responsibility for the paper as a whole.


  1. 1.
    Adhikari S, Fiorello A, Stolz L et al (2014) Ability of emergency physicians with advanced echocardiographic experience at a single center to identify complex echocardiographic abnormalities. Am J Emerg Med 32(4):363–366CrossRefPubMedGoogle Scholar
  2. 2.
    Hansegard J, Urheim S, Lunde K, Malm S, Rabben SI (2009) Semi-automated quantification of left ventricular volumes and ejection fraction by real-time three-dimensional echocardiography. Cardiovasc Ultrasound 7(18):1–10Google Scholar
  3. 3.
    Moore CL, Copel JA (2011) Point-of-care ultrasonography. N Engl J Med 364(8):749–757CrossRefPubMedGoogle Scholar
  4. 4.
    Labovitz AJ, Noble VE, Bierig M et al (2010) Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr 23(12):1225–1230CrossRefPubMedGoogle Scholar
  5. 5.
    Torres-Macho J, Antón-Santos JM, García-Gutierrez I et al (2012) Initial accuracy of bedside ultrasound performed by emergency physicians for multiple indications after a short training period. Am J Emerg Med 30(9):1943–1949CrossRefPubMedGoogle Scholar
  6. 6.
    Spencer KT, Kimura BJ, Korcarz CE, Pellikka PA, Rahko PS, Siegel RJ (2013) Focused cardiac ultrasound: recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr 26(6):567–581CrossRefPubMedGoogle Scholar
  7. 7.
    Jones AE, Tayal VS, Sullivan DM, Kline JA (2004) Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients*. Crit Care Med 32(8):1703–1708CrossRefPubMedGoogle Scholar
  8. 8.
    Borloz MP, Frohna WJ, Phillips CA, Antonis MS (2011) Emergency department focused bedside echocardiography in massive pulmonary embolism. J Emerg Med 41(6):658–660CrossRefPubMedGoogle Scholar
  9. 9.
    Andrew Taylor R, Oliva I, Van Tonder R, Elefteriades J, Dziura J, Moore CL (2012) Point-of-care focused cardiac ultrasound for the assessment of thoracic aortic dimensions, dilation, and aneurysmal disease. Acad Emerg Med 19(2):244–247CrossRefPubMedGoogle Scholar
  10. 10.
    Nazerian P, Vanni S, Castelli M et al (2014) Diagnostic performance of emergency transthoracic focus cardiac ultrasound in suspected acute type A aortic dissection. Int Emerg Med 9(6):665–670CrossRefGoogle Scholar
  11. 11.
    Chalifoux LA, Sullivan JT (2015) Applications of focused cardiac ultrasound (FoCUS) in obstetrics. Curr Anesthesiol Rep 5(1):106–113CrossRefGoogle Scholar
  12. 12.
    Mandavia DP, Hoffner RJ, Mahaney K, Henderson SO (2001) Bedside echocardiography by emergency physicians. Ann Emerg Med 38(4):377–382CrossRefPubMedGoogle Scholar
  13. 13.
    Moore CL, Rose GA, Tayal VS, Sullivan DM, Arrowood JA, Kline JA (2002) Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med 9(3):186–193CrossRefPubMedGoogle Scholar
  14. 14.
    Randazzo MR, Snoey ER, Levitt MA, Binder K (2003) Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med 10(9):973–977CrossRefPubMedGoogle Scholar
  15. 15.
    Am Dinh V, Ko HS, Rao R et al (2012) Measuring cardiac index with a focused cardiac ultrasound examination in the ED. Am J Emerg Med 30(9):1845–1851CrossRefPubMedGoogle Scholar

Copyright information

© Società Italiana di Ultrasonologia in Medicina e Biologia (SIUMB) 2017

Authors and Affiliations

  • Davood Farsi
    • 1
  • Skokoufeh Hajsadeghi
    • 2
  • Mohammad Javad Hajighanbari
    • 1
  • Mani Mofidi
    • 1
  • Peyman Hafezimoghadam
    • 1
  • Mahdi Rezai
    • 1
  • Babak Mahshidfar
    • 1
  • Samaneh Abiri
    • 1
  • Saeed Abbasi
    • 3
  1. 1.Emergency Department, Emergency Medicine Management Research CenterIran University of Medical SciencesTehranIran
  2. 2.Cardiology DepartmentIran University of Medical SciencesTehranIran
  3. 3.Emergency Department, Hazrat-Rasool HospitalIran University of Medical SciencesTehranIran

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