Determination of left ventricular function by emergency physician echocardiography of hypotensive patients

被引:153
作者
Moore, CL
Rose, GA
Tayal, VS
Sullivan, M
Arrowood, JA
Kline, JA
机构
[1] Carolinas Med Ctr, Dept Emergency Med, Charlotte, NC 28232 USA
[2] Virginia Commonwealth Univ, Med Coll Virginia, Dept Emergency Med, Richmond, VA 23298 USA
[3] Resurrection Med Ctr, Dept Emergency Med, Chicago, IL USA
关键词
echocardiography; ejection fraction; emergency medicine; hypotension; shock; ultrasound;
D O I
10.1111/j.1553-2712.2002.tb00242.x
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objective: To determine whether emergency physicians (EPs) with goal-directed training can use echocardiography to accurately assess left ventricular function (LVF) in hypotensive emergency department (ED) patients. Methods: Prospective, observational study at an urban teaching ED with >100,000 visits/year. Four EP investigators with prior ultrasound experience underwent focused echocardiography training. A convenience sample of 51 adult patients with symptomatic hypotension was enrolled. Exclusion criteria were a history of trauma, chest compressions, or electrocardiogram diagnostic of acute myocardial infarction. A five-view transthoracic echocardiogram. was recorded by an EP investigator who estimated ejection fraction (EF) and categorized LVF as normal, depressed, or severely depressed. A blinded cardiologist reviewed all 51 studies for EF, categorization of function, and quality of the study. Twenty randomly selected studies were reviewed by a second cardiologist to determine interobserver variability. Results: Comparison of EP vs. primary cardiologist estimate of EF Yielded a Pearson's correlation coefficient R = 0.86. This compared favorably with interobserver correlation between cardiologists (R = 0.84). In categorization of LVF, the weighted agreement between EPs and the primary cardiologist was 84%, with a weighted kappa of 0.61 (p < 0.001). Echocardiographic quality was rated by the primary cardiologist as good in 33%, moderate in 43%, and poor in 22%. The EF was significantly lower in patients with a cardiac cause of hypotension vs. other patients (25 +/- 10% vs. 48 +/- 17%, p < 0.001). Conclusions: Emergency physicians with focused training in echocardiography can accurately determine LVF in hypotensive patients.
引用
收藏
页码:186 / 193
页数:8
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