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Does physician experience influence the interpretability of focused echocardiography images performed by a pocket device?

Bobbia X, Pradeilles C, Claret PG, Soullier C, Wagner P, Bodin Y, Roger C, Cayla G, Muller L, de La Coussaye JE - Scand J Trauma Resusc Emerg Med (2015)

Bottom Line: If their opinions were divided, then a third expert concluded.The patient position was also associated with interpretable items: supine three [2; 4], "45°" three [1; 4], sitting two [1; 4] (p = .02).In multivariate analysis, only EP experience was associated with the number of interpretable items (p = .02).

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine. Intensive Care Unit, Nimes University Hospital, place du Pr Debré, 30029, Nîmes, France. xavier.bobbia@gmail.com.

ABSTRACT

Introduction: The use of focused cardiac ultrasound (FoCUS) in a prehospital setting is recommended. Pocket ultrasound devices (PUDs) appear to be well suited to prehospital FoCUS. The main aim of our study was to evaluate the interpretability of echocardiography performed in a prehospital setting using a PUD based on the experience of the emergency physician (EP).

Methods: This was a monocentric prospective observational study. We defined experienced emergency physicians (EEPs) and novice emergency physicians (NEPs) as echocardiographers if they had performed 50 echocardiographies since their initial university training (theoretical training and at least 25 echocardiographies performed with a mentor). Each patient undergoing prehospital echocardiography with a PUD was included. Four diagnostic items based on FoCUS were analyzed: pericardial effusions (PE), right ventricular dilation (RVD), qualitative left ventricular function assessment (LVEF), and inferior vena cava compliance (IVCC). Two independent experts blindly evaluated the interpretability of each item by examining recorded video loops. If their opinions were divided, then a third expert concluded.

Results: Fourteen EPs participated: eight (57 %) EEPs and six (43 %) NEPs. Eighty-five patients were included: 34 (40 %) had an echocardiography by an NEP and 51 (60 %) by an EEP. The mean number of interpretable items by echocardiography was three [1; 4]; one [0; 2.25] in the NEP group, four [3; 4] in EEP (p < .01). The patient position was also associated with interpretable items: supine three [2; 4], "45°" three [1; 4], sitting two [1; 4] (p = .02). In multivariate analysis, only EP experience was associated with the number of interpretable items (p = .02). Interpretability by NEPs and EEPs was: 56 % vs. 96 % for LVF, 29 % vs. 98 % for PE, 26 % vs. 92 % for RVD, and 21 % vs. 67 % for IVCC (p < .01 for all).

Conclusion: FoCUS with PUD in prehospital conditions was possible for EEPs, It is difficult and the diagnostic yield is poor for NEPs.

No MeSH data available.


Related in: MedlinePlus

Number of interpretable echocardiography items for each exam according to physician experience. EEP: experienced emergency physician; NEP: novice emergency physician (almost 50 echocardiographies after initial training); “Echography rate” is the rate of examinations with 0, 1, 2, 3, or 4 interpretable items
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Fig1: Number of interpretable echocardiography items for each exam according to physician experience. EEP: experienced emergency physician; NEP: novice emergency physician (almost 50 echocardiographies after initial training); “Echography rate” is the rate of examinations with 0, 1, 2, 3, or 4 interpretable items

Mentions: The mean number of interpretable items by echocardiography was three [1;4]; one [0;2.25] in the NEP group, four [3; 4] in the EEP group (p < .01). The correlations between interpretable echocardiography items for each exam according to the EP’s experience are shown in Fig. 1. LVEF was interpretable in 68 (80 %) patients, PE in 60 (81%), RVD in 56 (66 %), and IVCC in 41 (48 %). Fig. 2 shows interpretability of each echocardiography item, according to the EP’s experience.Fig. 1


Does physician experience influence the interpretability of focused echocardiography images performed by a pocket device?

Bobbia X, Pradeilles C, Claret PG, Soullier C, Wagner P, Bodin Y, Roger C, Cayla G, Muller L, de La Coussaye JE - Scand J Trauma Resusc Emerg Med (2015)

Number of interpretable echocardiography items for each exam according to physician experience. EEP: experienced emergency physician; NEP: novice emergency physician (almost 50 echocardiographies after initial training); “Echography rate” is the rate of examinations with 0, 1, 2, 3, or 4 interpretable items
© Copyright Policy - open-access
Related In: Results  -  Collection

License 1 - License 2
Show All Figures
getmorefigures.php?uid=PMC4493952&req=5

Fig1: Number of interpretable echocardiography items for each exam according to physician experience. EEP: experienced emergency physician; NEP: novice emergency physician (almost 50 echocardiographies after initial training); “Echography rate” is the rate of examinations with 0, 1, 2, 3, or 4 interpretable items
Mentions: The mean number of interpretable items by echocardiography was three [1;4]; one [0;2.25] in the NEP group, four [3; 4] in the EEP group (p < .01). The correlations between interpretable echocardiography items for each exam according to the EP’s experience are shown in Fig. 1. LVEF was interpretable in 68 (80 %) patients, PE in 60 (81%), RVD in 56 (66 %), and IVCC in 41 (48 %). Fig. 2 shows interpretability of each echocardiography item, according to the EP’s experience.Fig. 1

Bottom Line: If their opinions were divided, then a third expert concluded.The patient position was also associated with interpretable items: supine three [2; 4], "45°" three [1; 4], sitting two [1; 4] (p = .02).In multivariate analysis, only EP experience was associated with the number of interpretable items (p = .02).

View Article: PubMed Central - PubMed

Affiliation: Department of Anesthesiology, Emergency and Critical Care Medicine. Intensive Care Unit, Nimes University Hospital, place du Pr Debré, 30029, Nîmes, France. xavier.bobbia@gmail.com.

ABSTRACT

Introduction: The use of focused cardiac ultrasound (FoCUS) in a prehospital setting is recommended. Pocket ultrasound devices (PUDs) appear to be well suited to prehospital FoCUS. The main aim of our study was to evaluate the interpretability of echocardiography performed in a prehospital setting using a PUD based on the experience of the emergency physician (EP).

Methods: This was a monocentric prospective observational study. We defined experienced emergency physicians (EEPs) and novice emergency physicians (NEPs) as echocardiographers if they had performed 50 echocardiographies since their initial university training (theoretical training and at least 25 echocardiographies performed with a mentor). Each patient undergoing prehospital echocardiography with a PUD was included. Four diagnostic items based on FoCUS were analyzed: pericardial effusions (PE), right ventricular dilation (RVD), qualitative left ventricular function assessment (LVEF), and inferior vena cava compliance (IVCC). Two independent experts blindly evaluated the interpretability of each item by examining recorded video loops. If their opinions were divided, then a third expert concluded.

Results: Fourteen EPs participated: eight (57 %) EEPs and six (43 %) NEPs. Eighty-five patients were included: 34 (40 %) had an echocardiography by an NEP and 51 (60 %) by an EEP. The mean number of interpretable items by echocardiography was three [1; 4]; one [0; 2.25] in the NEP group, four [3; 4] in EEP (p < .01). The patient position was also associated with interpretable items: supine three [2; 4], "45°" three [1; 4], sitting two [1; 4] (p = .02). In multivariate analysis, only EP experience was associated with the number of interpretable items (p = .02). Interpretability by NEPs and EEPs was: 56 % vs. 96 % for LVF, 29 % vs. 98 % for PE, 26 % vs. 92 % for RVD, and 21 % vs. 67 % for IVCC (p < .01 for all).

Conclusion: FoCUS with PUD in prehospital conditions was possible for EEPs, It is difficult and the diagnostic yield is poor for NEPs.

No MeSH data available.


Related in: MedlinePlus