Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists
Abstract Background Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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SpringerOpen
2018-12-01
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| Series: | Critical Ultrasound Journal |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s13089-018-0113-4 |
| _version_ | 1818135597480411136 |
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| author | Rosemary Thomas-Mohtat Craig Sable Kristen Breslin Jacqueline G. Weinberg Aparna Prasad Lauren Zinns Joanna S. Cohen |
| author_facet | Rosemary Thomas-Mohtat Craig Sable Kristen Breslin Jacqueline G. Weinberg Aparna Prasad Lauren Zinns Joanna S. Cohen |
| author_sort | Rosemary Thomas-Mohtat |
| collection | DOAJ |
| description | Abstract Background Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition. Methods PEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard. Subsequently, eight different PEM fellows remotely interpreted a subset of the PEM-acquired and cardiology-acquired echocardiograms. Results Eight PEM fellows performed 54 FOCUS exams, of which two had pericardial effusion and four had diminished function. PEM fellow FOCUS had a sensitivity of 50.0% (95% CI 9.19–90.8) and specificity of 100.0% (95% CI 91.1–100.0) for detecting diminished function, and sensitivity of 50.0% (95% CI 2.67–97.33) and specificity of 98.1% (95% CI 88.42–99.9) for detecting pericardial effusions. When PEM fellows remotely interpreted 15 echocardiograms, the sensitivity was 81.3% (95% CI 70.7–88.8) and specificity 75% (95% CI 67.0–81.0) for detecting diminished function, and sensitivity of 76.3% (95% CI 65.0–85.0) and specificity 94.4% (95% CI 89.0–97.0) for detecting pericardial effusion. There were no differences in sensitivity and specificity of PEM fellows’ interpretation of FOCUS studies compared to their interpretation of cardiology echocardiograms. Interrater reliability for interpretation of remote images (kappa) was 0.66 (95% CI 0.59–0.73) for effusion and 0.31 (95% CI 0.24–0.38) for function among the fellows. Conclusion Novice PEM fellow sonologists (a physician who performs and interprets ultrasound) in the majority of instances were able to acquire and remotely interpret FOCUS images with limited training. However, they made real-time interpretation errors and likely need further training to incorporate real-time image acquisition and interpretation into their practice. |
| first_indexed | 2024-12-11T09:27:03Z |
| format | Article |
| id | doaj.art-1837393d99e54dd98f89d8bb3644cee3 |
| institution | Directory Open Access Journal |
| issn | 2036-3176 2036-7902 |
| language | English |
| last_indexed | 2024-12-11T09:27:03Z |
| publishDate | 2018-12-01 |
| publisher | SpringerOpen |
| record_format | Article |
| series | Critical Ultrasound Journal |
| spelling | doaj.art-1837393d99e54dd98f89d8bb3644cee32022-12-22T01:13:07ZengSpringerOpenCritical Ultrasound Journal2036-31762036-79022018-12-011011910.1186/s13089-018-0113-4Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologistsRosemary Thomas-Mohtat0Craig Sable1Kristen Breslin2Jacqueline G. Weinberg3Aparna Prasad4Lauren Zinns5Joanna S. Cohen6Department of Emergency Medicine and Trauma Services, Children’s National Medical CenterDepartment of Cardiology, Children’s National Medical CenterDepartment of Emergency Medicine and Trauma Services, Children’s National Medical CenterDepartment of Cardiology, Children’s Hospital of PittsburghDepartment of Cardiology, Goryeb Children’s HospitalDepartment of Emergency Medicine, Icahn School of Medicine at Mt. SinaiDepartment of Emergency Medicine and Trauma Services, Children’s National Medical CenterAbstract Background Focused cardiac ultrasound (FOCUS) is a core competency for pediatric emergency medicine (PEM) fellows. The objectives of this study were (1) to evaluate test characteristics of PEM-fellow-performed FOCUS for pericardial effusion and diminished cardiac function and (2) to assess image interpretation independent of image acquisition. Methods PEM fellows performed and interpreted FOCUS on patients who also received cardiology service echocardiograms, the reference standard. Subsequently, eight different PEM fellows remotely interpreted a subset of the PEM-acquired and cardiology-acquired echocardiograms. Results Eight PEM fellows performed 54 FOCUS exams, of which two had pericardial effusion and four had diminished function. PEM fellow FOCUS had a sensitivity of 50.0% (95% CI 9.19–90.8) and specificity of 100.0% (95% CI 91.1–100.0) for detecting diminished function, and sensitivity of 50.0% (95% CI 2.67–97.33) and specificity of 98.1% (95% CI 88.42–99.9) for detecting pericardial effusions. When PEM fellows remotely interpreted 15 echocardiograms, the sensitivity was 81.3% (95% CI 70.7–88.8) and specificity 75% (95% CI 67.0–81.0) for detecting diminished function, and sensitivity of 76.3% (95% CI 65.0–85.0) and specificity 94.4% (95% CI 89.0–97.0) for detecting pericardial effusion. There were no differences in sensitivity and specificity of PEM fellows’ interpretation of FOCUS studies compared to their interpretation of cardiology echocardiograms. Interrater reliability for interpretation of remote images (kappa) was 0.66 (95% CI 0.59–0.73) for effusion and 0.31 (95% CI 0.24–0.38) for function among the fellows. Conclusion Novice PEM fellow sonologists (a physician who performs and interprets ultrasound) in the majority of instances were able to acquire and remotely interpret FOCUS images with limited training. However, they made real-time interpretation errors and likely need further training to incorporate real-time image acquisition and interpretation into their practice.http://link.springer.com/article/10.1186/s13089-018-0113-4Point of care ultrasoundFocused cardiac ultrasoundEducationPediatric emergency medicine |
| spellingShingle | Rosemary Thomas-Mohtat Craig Sable Kristen Breslin Jacqueline G. Weinberg Aparna Prasad Lauren Zinns Joanna S. Cohen Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists Critical Ultrasound Journal Point of care ultrasound Focused cardiac ultrasound Education Pediatric emergency medicine |
| title | Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists |
| title_full | Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists |
| title_fullStr | Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists |
| title_full_unstemmed | Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists |
| title_short | Interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists |
| title_sort | interpretation errors in focused cardiac ultrasound by novice pediatric emergency medicine fellow sonologists |
| topic | Point of care ultrasound Focused cardiac ultrasound Education Pediatric emergency medicine |
| url | http://link.springer.com/article/10.1186/s13089-018-0113-4 |
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