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

摘要

Introduction Few studies have assessed the value andrnaccuracy of focused cardiac ultrasound (FOCUS) performedrnby emergency physicians. The aim of the present study wasrnto evaluate the diagnostic accuracy of FOCUS performed byrnemergency medicine residents compared to echocardiographyrnperformed by a cardiologist in emergency departmentrn(ED) patients suspected of cardiovascular disease.rnMethods The research involved a prospective observationalrncross-sectional study enrolling patients over 18-years oldrnsuspected of having cardiovascular disease who required anrnechocardiograph. For each patient, a FOCUS test was conductedrnby a trained emergency medicine resident. Therndiagnostic accuracy ofEDperformed FOCUS was comparedrnto echocardiography performed by a cardiologist (goldrnstandard) in the ED. Sensitivity, specificity, positive andrnnegative predictive values, and likelihood ratios were calculatedrnfor FOCUS. The agreement of EM residents andrncardiologists on each finding was evaluated using Cohen’srnkappa coefficient with 95% CI.rnResults Two hundred and five patients, with a mean age ofrn61.0 ± 17 years (50% male), were included in this study.rnAgreement between FOCUS performed by an emergencyrnmedicine resident and echocardiography performed by arncardiologist in measuring ejection fraction of the leftrnventricle was 91% (j = 0.85; 95% CI = 0.79–0.91).rnReports of the two groups for identifying right ventricularrnenlargement showed 96% agreement (j = 0.86; 95%rnCI = 0.82–0.90). The agreements for right ventricularrnpressure overload, wall motion abnormality and pericardialrneffusion were 100% (j = 0.83; 95% CI = 0.77–0.89),rn92% (j = 0.83; 95% CI = 0.76–0.90), and 96%rn(j = 0.83; 95% CI = 0.77–0.89), respectively.rnConclusion FOCUS performed by emergency medicinernresidents is comparable to echocardiography performed byrncardiologists. Therefore, it could be a reliable tool and screening test for initial testing of patients suspected ofrncardiac abnormalities.