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

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Abstract

Introduction

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.

Methods

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.

Results

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.

Conclusion

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.

Sommario

Introduzione

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.

Metodi

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.

Risultati

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.

Conclusioni

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.

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Authors and Affiliations

  1. Emergency Department, Emergency Medicine Management Research Center, Iran University of Medical Sciences, Tehran, Iran

    Davood Farsi, Mohammad Javad Hajighanbari, Mani Mofidi, Peyman Hafezimoghadam, Mahdi Rezai, Babak Mahshidfar & Samaneh Abiri

  2. Cardiology Department, Iran University of Medical Sciences, Tehran, Iran

    Skokoufeh Hajsadeghi

  3. Emergency Department, Hazrat-Rasool Hospital, Iran University of Medical Sciences, Niayesh St., Sattarkhan St., Tehran, Iran

    Saeed Abbasi

Authors
  1. Davood Farsi
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  2. Skokoufeh Hajsadeghi
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  3. Mohammad Javad Hajighanbari
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  4. Mani Mofidi
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  5. Peyman Hafezimoghadam
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  6. Mahdi Rezai
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  7. Babak Mahshidfar
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  8. Samaneh Abiri
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  9. Saeed Abbasi
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Corresponding author

Correspondence to Saeed Abbasi.

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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.

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Farsi, D., Hajsadeghi, S., Hajighanbari, M.J. et al. Focused cardiac ultrasound (FOCUS) by emergency medicine residents in patients with suspected cardiovascular diseases. J Ultrasound 20, 133–138 (2017). https://doi.org/10.1007/s40477-017-0246-5

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  • DOI: https://doi.org/10.1007/s40477-017-0246-5

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