A Comparison of Bedside Ultrasonography Use by Emergency Medicine Residents With 2D Echocardiography Performed by Sonographers for Assessing Left Ventricular Systolic Function in a Tertiary Hospital: A Single-Center Prospective Study.

BACKGROUND

Point-of-care ultrasound (POCUS) has become a crucial tool in the emergency department, aiding in rapid patient assessment and diagnosis, particularly in cases of acute dyspnea, which can have life-threatening causes. This study explores the diagnostic accuracy of PoCUS performed by emergency medicine residents, utilizing visual estimation and E-Point Septal Separation (EPSS) methods, in comparison to conventional 2D echocardiograms interpreted by sonographers.

METHODS

A total of 112 adult patients with acute dyspnea were included in this non-inferiority study. Visual estimation and EPSS measurements were performed by trained emergency medicine residents, with the results compared to 2D echocardiograms for sensitivity, specificity, positive and negative predictive values, likelihood ratios, receiver operating characteristic curve and diagnostic accuracy.

RESULTS

The study demonstrated a moderate positive correlation between visual estimation and EPSS methods and 2D echocardiography findings, with a Spearman's correlation coefficient of 0.422 and 0.411, respectively. The visual estimation method showed higher positive likelihood ratios (107) and sensitivity (100%) for detecting severely reduced ejection fraction (EF) < 30%, while EPSS displayed slightly lower positive likelihood ratios (13.4) and sensitivity (100%) in the same category. The diagnostic accuracy for both methods was highest in patients with severely depressed EF and lowest in those with moderately depressed EF. The study revealed some discrepancies in classification between methods, with visual estimation and EPSS sometimes underestimating or overestimating EF, potentially due to patient factors and operator-dependent bias.

CONCLUSION

This study demonstrates that visual estimation and EPSS methods, when performed by emergency medicine residents, exhibit a moderate positive correlation with 2D echocardiography findings. These methods offer a statistically significant diagnostic accuracy in estimating left ventricular ejection fraction, making them valuable tools for initial assessment in time-sensitive situations.