Accuracy of emergency physician-performed limited echocardiography for right ventricular strain

Background: Pulmonary embolism (PE) is a common emergency department (ED) diagnosis with a wide range in mortality rates. Methods to identify and risk-stratify PE, including measuring right ventricular strain (RVS) by echocardiography (echo), are essential in providing effective and efficient care. A limited echo examination aims to expedite and increase availability of RVS determination through assessment at the bedside by the ED provider.

Objective: The objective is to determine the level of agreement and test characteristics of right ventricular dilation (RVd), as a marker of RVS, on limited echo compared with consultative echo.

Methods: This is a retrospective cohort study of consecutive ED patients undergoing limited echo examinations for chest pain, dyspnea, or hypotension and a subsequent consultative echo within 72 hours. κ values and test characteristics were calculated to determine the level of agreement and accuracy between the limited echo examination and consultative echo for RVd and RVS.

Results: There were 411 focused examinations performed by 69 different providers over a 12-month period (median, 5 examinations per provider). The prevalence of RVS on limited echo examination was 6.2% (n = 25). The κ value for the level of agreement between limited and consultative echo for RVd was 0.44 (95% confidence intervals [CI], 0.27-0.61). The specificity of RVd on limited echo for RVS was 0.98 (95% CI, 0.96-0.99) with 6 false-positive categorizations, whereas the sensitivity was 0.26 (95% CI, 0.16-0.37).

Conclusions: In this retrospective cohort study, limited echo demonstrated moderate agreement with consultative echo for RVd. Right ventricular dilation on limited echo was highly specific for RVS but had low sensitivity.