Abstract
Background
Cardiopulmonary ultrasound (CPUS) is commonly used to assess cardiac function and
preload status in patients with septic shock. However, the reliability of CPUS findings
at the point of care is unknown.
Objective
To assess interrater reliability (IRR) of CPUS in patients with suspected septic shock
between treating emergency physicians (EPs) vs emergency ultrasound (EUS) experts.
Methods
Single-center, prospective, observational cohort enrolling patients (n = 51) with
hypotension and suspected infection. Treating EPs performed and interpreted CPUS for
cardiac function parameters (left ventricular [LV] function and right ventricular
[RV] function and size) and preload volume parameters (inferior vena cava [IVC] diameter
and pulmonary B-lines). The primary outcome was IRR (assessed by Kappa values [κ]
and intraclass correlation coefficient [ICC]) between EP and EUS-expert consensus.
Secondary analyses examined the effects on IRR of operator experience, respiratory
rate, and known difficult views on a Cardiology-performed echocardiogram.
Results
IRR was fair for LV function, κ = 0.37, 95% confidence interval (CI) 0.1–0.64; poor
for RV function, κ = −0.05, 95% CI −0.6–0.5; moderate for RV size, κ = 0.47, 95% CI
0.07–0.88; and substantial for B-lines, κ = 0.73, 95% CI 0.51–0.95 and IVC size, ICC = 0.87,
95% CI 0.2–0.99. Involvement of ultrasound-trained faculty was associated with improved
IRR of RV size (p = 0.002), but not other CPUS domains.
Conclusions
Our study demonstrated high IRR for preload volume parameters (IVC size and presence
of B-lines), but not for cardiac parameters (LV function and RV function and size)
in patients presenting with concern for septic shock. Future research must focus on
determining sonographer and patient-specific factors affecting CPUS interpretation
in real-time.
Keywords
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Article info
Publication history
Published online: December 22, 2022
Accepted:
December 13,
2022
Received in revised form:
November 14,
2022
Received:
September 2,
2022
Publication stage
In Press Uncorrected ProofIdentification
Copyright
© 2023 Elsevier Inc. All rights reserved.
