Interrater Reliability of Point-of-Care Cardiopulmonary Ultrasound in Patients With Septic Shock: An Analysis of Agreement Between Treating Clinician and Expert Reviewers

Background: Cardiopulmonary ultrasound (CPUS) is commonly used to assess cardiac function and preload status in patients with septic shock. However, the re-liability 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 sus-pected 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] di-ameter and pulmonary B-lines). The primary outcome was IRR (assessed by Kappa values [ K] and intraclass correlation coefficient [ICC]) between EP and EUS-expert consensus. Secondary analyses examined the effects on IRR of opera-tor experience, respiratory rate, and known difficult views on a Cardiology-performed echocardiogram. Results: IRR was fair for LV function, K = 0.37, 95% confidence inter-val (CI) 0.1-0.64; poor for RV function, K = -0.05, 95% CI -0.6-0.5; moderate for RV size, K = 0.47, 95% CI 0.07-0.88; and substantial for B-lines, K = 0.73, 95% CI 0.51-0.95 and IVC size, ICC = 0.87, 95% CI 0.2-0.99. In-volvement 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 determin-ing sonographer and patient-specific factors affecting CPUS interpretation in real-time. (c) 2023 Elsevier Inc. All rights reserved.