Accuracy of radiographic readings in the emergency department

Objectives

A review of radiology discrepancies of emergency department (ED) radiograph interpretations was undertaken to examine the types of error made by emergency physicians (EPs).

Methods

An ED quality assurance database containing all radiology discrepancies between the EP and radiology from June 1996 to May 2005 was reviewed. The discrepancies were categorized as bone, chest (CXR), and abdomen (AXR) radiographs and examined to identify abnormalities missed by EPs.

Results

During the study period, the ED ordered approximately 151?693 radiographs. Of the total, 4605 studies were identified by radiology as having a total of 5308 abnormalities discordant from the EP interpretation. Three hundred fifty-nine of these abnormalities were not confirmed by the radiologist (false positive). The remainder of the discordant studies represented abnormalities identified by the radiologist and missed by the EP (false negatives). Of these false-negative studies, 1954 bone radiographs (2.4% of bone x-rays ordered) had missed findings with 2050 abnormalities; the most common missed findings were fractures and dislocations. Of the 220 AXRs (3.7% of AXRs ordered) with missed findings, 240 abnormalities were missed; the most common of these was bowel obstruction. Of the 2431 CXRs (3.8% of CXRs ordered), 2659 abnormalities were missed; the most common were air-space disease and pulmonary nodules. The rate of discrepancies potentially needing emergent change in management based solely on a radiographic discrepancy was 85 of 151?693 x-rays (0.056%).

Conclusions

Approximately 3% of radiographs interpreted by EPs are subsequently given a discrepant interpretation by the radiology attending. The most commonly missed findings included fractures, dislocations, air-space disease, and pulmonary nodules. Continuing education should focus on these areas to attempt to further reduce this error rate.     

Efficacy of the posttraumatic cross table lateral view of the cervical spine

This is a retrospective study of 128 patients with a discharge diagnosis of cervical spine fracture, dislocation, or subluxation. The study was undertaken to establish the accuracy of the posttraumatic cross table lateral view radiograph of the cervical spine (CTLV). The radiographs were read by the faculty emergency physician author. If his diagnosis differed from the patient's final radiologic diagnosis, the radiograph was reevaluated by the radiologist author. The accuracy in diagnosing posttraumatic cervical spine abnormalities on CTLV alone was 74.2% and 79.7% for the emergency physician and radiologist, respectively. Thirty percent of cases undiagnosed by the emergency physician were subsequently treated as unstable injuries. Thirty-five percent of C1, 14.8% of C2, and 42.4% of C6 abnormalities were missed on CTLV by both the emergency physician and the radiologist. The results indicate that the CTLV, alone, is unreliable and potentially dangerous as a screening exam in diagnosing posttraumatic abnormalities of the cervical spine.     

Does the Lateral Chest Radiograph Help Pediatric Emergency Physicians Diagnose Pneumonia? A Randomized Clinical Trial

OBJECTIVES: To determine whether the addition of the lateral chest radiograph to the frontal view influences the pediatric emergency physician's diagnosis and management of patients with pneumonia. METHODS: A randomized clinical trial was conducted, involving 570 patients, 1-16 years of age, visiting a pediatric emergency department (ED) for whom frontal and lateral chest radiographs were ordered for the clinical suspicion of pneumonia. Pediatric emergency physicians reviewed the frontal film alone in group 1 and both the frontal and the lateral films in group 2. The interpretation of each radiograph was then compared with consensus interpretation by pediatric radiologists who interpreted both views. RESULTS: There were 604 eligible children; 34 families declined to participate. Three hundred three were randomized into group 1, whereas 267 were randomized into group 2. The clinicians' interpretations were equal in sensitivity for group 1 at 91% and 87% in group 2 (p = 0.321) and equal in specificity for group 1 at 58% and 57% in group 2 (p = 0.888). CONCLUSIONS: The addition of the lateral chest radiograph to the frontal view did not improve the sensitivity or specificity of pediatric emergency physicians in their diagnosis of pneumonia in children.     

Can nurses working in remote units accurately request and interpret radiographs?

Methods: In this prospective study the four qualified nurses working in a peripheral unit were permitted to request a defined set of radiographs after limb trauma. A written protocol for nurse requested radiographs was supported by individual teaching sessions. At the time that the radiograph was requested basic demographic details were recorded and the patient was also assessed by two senior doctors in emergency medicine, one in person and one via a telemedicine link, both of whom independently considered whether the radiograph requested by the nurse was appropriate in that patient. Nursing staff were also asked to provide a provisional interpretation of each film, and this was compared with a gold standard derived from the interpretations of the two emergency physicians who had seen the patient and the final radiologist's report.

Results: The first 300 patients who had a radiograph requested by a member of the nursing staff were studied over a period of 12 months. Altogether 93 radiographs (31%) were positive for recent bony trauma or radio-opaque foreign body. Eleven radiographs (3.7%) were judged by both emergency physicians to be inappropriate. Three radiographs (1%) were requested outside the limits of the protocol, but all three were judged to be appropriate and occurred within the first two months of the study. A total of 32 (10.7%) of the radiographs were incorrectly interpreted by nursing staff with 26 false positives, four false negatives and two cases where the nurse observed an abnormality but failed to identify it correctly. The sensitivity of nurse interpretation was therefore 96%, with a specificity of 87%.

Conclusion: Experienced nurses, working without continuous medical supervision in a remote unit, are able to request appropriate radiographs of the peripheral limbs. Nurses requesting radiographs in this way can also interpret these films to a high standard, though with a tendency to err on the side of caution, generating many more false positive results than false negatives.

     

Clinical Clearance of Cervical Spinal Injuries by Emergency Nurses

OBJECTIVES: To determine the interrater reliability between emergency nurses and emergency physicians on defined criteria for clinically clearing the cervical spine in blunt trauma patients. METHODS: Blunt trauma patients, 12 years or older, arriving with cervical spinal precautions were prospectively enrolled as a convenience sample. Each member of the emergency physician-nurse pair completed a questionnaire with regard to five criteria for clinically clearing the cervical spine for each patient. Interrater reliability was determined by calculating the kappa statistics for the individual and combined criteria. RESULTS: Physicians and nurses agreed on the presence or absence of the combined criteria in 175 of 211 patients (82.9%; kappa, 0.65). Agreements on individual criteria were as follows: 1) intoxication--203 patients (96.2%; kappa, 0.82); 2) altered consciousness--197 patients (93.4%; kappa, 0.60); 3) neck pain--185 patients (87.7%; kappa, 0.75); 4) distracting injury--160 patients (75.8%; kappa, 0.36); and 5) neurologic deficit--198 patients (93.8%; kappa, 0.45). If disagreements in which the physician would clinically clear the patient but the nurse would not were considered as agreements, then overall agreement would be 198 of 211 patients (93.8%; kappa, 0.88). On the assumption that nurses would assess patients prior to physicians, they would have cleared 35% of the patients before the physicians. However, they would have ordered 12% more radiographs and unsafely clinically cleared 5% of the patients. CONCLUSIONS: The interrater reliability for the combined cervical spinal injury criteria between emergency nurses and physicians was good to excellent. However, with the training given in this study, nurses would order more radiographs than physicians and would unsafely clinically clear cervical spines in some patients.     

The accuracy of adult limb radiograph interpretation by emergency nurse practitioners: A prospective comparative study

Background

One of the extensions to practice for the emergency nurse practitioner role is to appropriately order and interpret radiographs in the emergency department.

Objective

The aim of the study was to compare the accuracy in interpreting isolated adult limb radiographs between emergency nurse practitioners and emergency physicians.

Design

A prospective comparative study was undertaken.

Setting

Emergency department in a large metropolitan hospital.

Participants

200 adult patients with isolated limb injuries were consented.

Methods

Six emergency nurse practitioners and ten emergency physicians participated. One emergency physician and emergency nurse practitioner independently clinically assessed each patient, determined the need for radiograph and separately recorded their interpretation of the radiograph as either definite fracture, no fracture or possible fracture. A single consultant radiologist reviewed each radiograph and their interpretation was seen as the gold standard. The sensitivity and specificity of emergency physicians and emergency nurse practitioners were calculated. To measure the level of agreement between the two-clinician groups, the weighted Kappa statistic was used.

Results

The sensitivity for the emergency nurse practitioners was 91% and 88% for the emergency physicians. The specificity for the emergency nurse practitioners was 85% and for the emergency physicians 91%. The weighted Kappa on the presence of a fracture between the emergency nurse practitioners and emergency physicians was 0.83.

Conclusions

This study validates the clinical and diagnostic skills of emergency nurse practitioners assessed in the interpretation of isolated adult limb injury radiographs.     

Radiograph ordering: Agreement between the triage nurse and the physician in a pediatric emergency department

We hypothesized that the triage nurse in a busy pediatric emergency department (ED) could accurately order radiographs, ultimately reducing patient waiting time. Protocols utilized to reduce patient waiting time are of importance in busy emergency departments. All patients registering at the ED of the Children's Hospital in a one-week period were entered into the study. The triage nurse documented whether they would send the patient for a radiograph, if allowed to, and were asked to designate a specific radiograph. The radiographs that were actually ordered by the physicians were subsequently obtained from radiology records. Data were analyzed for agreement beyond chance (kappa), positive (PPV) and negative predictive values. The results showed excellent agreement for extremity radiographs and poor agreement for nonextremity radiographs.     

Clinical impact of radiograph misinterpretation in a pediatric ED and the effect of physician training level

Radiograph interpretation in the pediatric emergency department (ED) is commonly performed by pediatric emergency medicine (PEM) attendings or physicians-in-training. This study examines the effect of physician training level on radiograph interpretation and the clinical impact of false-negative radiograph interpretations. Data were collected on 1,471 radiographs of the chest, abdomen, extremity, lateral neck, and cervical spine interpreted by PEM attendings, one PEM fellow, one physician assistant, and emergency medicine, pediatric and family practice residents. Two hundred radiographs (14%) were misinterpreted, including 141 chest (16%), 24 extremity (8%), 20 abdomen (12%), 14 lateral neck (18%), and 1 cervical spine radiograph (2%). Physicians-in-training misinterpreted 16% of their radiographs versus 11% for PEM attendings (P = .01). Twenty (1.4%) radiographs had clinically significant (false-negative) misinterpretations, including 1.7% of physician-in-training and 0.8% of attending interpretations (P = 0.15). No morbidity resulted from the delay in correct interpretation. Radiograph misinterpretation by ED physicians occurs but is unlikely to result in significant morbidity.     

Prereduction radiographs in clinically evident anterior shoulder dislocation

The main study objective was to determine if experienced emergency physicians can accurately identify a subgroup of patients with anterior shoulder dislocation for whom prereduction radiographs do not alter patient management. Our prospective study evaluated 97 patients who presented to 2 ski-hill clinics and to our rural emergency department with possible shoulder dislocation between November 1996 and May 1997. Emergency physicians were certain of shoulder dislocation by clinical examination alone in 40 of 59 cases (67.8%) of possible dislocation. All 40 cases were found to have a dislocation (100%; 95% Cl, 91.19% to 100%), and the prereduction radiograph did not affect management of the injury. Prereduction radiographs added 29.6 +/- 12.68 minutes to treatment. We conclude that shoulder dislocation is often readily apparent from history and physical examination. When the experienced emergency physician is certain of the diagnosis of anterior shoulder dislocation, prereduction radiography delays treatment and does not alter management.     

Out of hours non-contrast head CT scan interpretation by senior emergency department medical staff

Objective: To assess the accuracy of ‘out of hours’ (17.00–08.00 hours) non‐contrast head computed tomography (NCHCT) scan interpretation by senior ED medical staff. Methods: The study was undertaken in an inner‐city tertiary hospital in Sydney. A sample of 315 consecutive ‘out of hours’ NCHCT scans was compiled from a log book in the Medical Imaging Department and randomized into 21 sets of 15 scans. The scans were reviewed by emergency physicians and registrars recruited for the study and their interpretations were compared with the formal radiologist report. Results: Seven emergency physicians and 14 registrars took part in the study. Two hundred and eighty‐seven ED interpretations were used in the 2 × 2 table analysis. The overall observed agreement was 0.67 (95% confidence interval [CI] 0.61–0.72), sensitivity 0.57 (95% CI 0.45–0.69), specificity 0.70 (95% CI 0.64–0.76) and kappa 0.24 (95% CI 0.13–0.36). There were 32 false negative interpretations including three small contre coup contusions and three subdural haemorrhages. Conclusion: ‘Out of hours’ NCHCT scan interpretation by senior ED medical staff is only correct two‐thirds of the time. Further education for all senior ED staff is indicated to improve our accuracy. The safety of NCHCT scan interpretation by senior ED medical staff needs further study.     

Analysis of emergency department interpretation of electrocardiograms.

The objective of the study was to determine the concordance of emergency physicians' and cardiologists' interpretations of emergency department (ED) electrocardiograms (ECG), to evaluate the impact of ECG misinterpretation on patient management, and to determine error rates as a function of the level of physician training and the specific ECG diagnoses. ECG interpretations were registered prospectively using a programmed-response data sheet. A second blinded interpretation by a staff cardiologist was assumed to be correct. Only ECG discrepancies with potential or probable clinical importance were considered as errors. The ED management of patients with ECG misinterpretations was reviewed by the investigators. The study was performed at an urban university hospital using 300 consecutive ED ECGs. The analysis found 154 errors of interpretation of which nine had probable clinical significance, and 56 had indeterminant significance. The concordance was weak at 0.69 (Kappa = 0.32, weighted Kappa = 0.30) with a significant discordance (McNemar Chi 2:P < 0.05). Error rates did not differ significantly between the diverse categories of physicians. In two cases, interpretation errors impacted patient management decisions but not patient outcomes. The most frequent errors involved repolarization abnormalities, ventricular hypertrophy and hemi-blocks. While discordance was significant, errors in ECG interpretation rarely impacted patient management. Prospective evaluation of ECG interpretation may be a useful means of gauging physician skills. It can also serve to focus educational activities on problem areas in electrocardiography.     

Can x rays be accurately interpreted using a low cost telemedicine system?

OBJECTIVE: To assess whether the quality of x ray films transmitted via a low cost (low resolution) telemedicine link was satisfactory for clinical diagnosis. METHODS: A retrospective study of a set of consecutive accident and emergency (A&E) radiographs. An A&E registrar viewed these directly on a standard x ray viewing box and via a telemedicine link. RESULTS: There were 81 abnormalities out of 234 x ray films. Three abnormalities were missed both on the x ray viewing box and telemedicine link, one of which was significant. There were five additional abnormalities missed on the telemedicine link but detected on the x ray viewing box, of which two were significant. One normal x ray film was interpreted as abnormal on the telemedicine link. There were no false positives on direct viewing. CONCLUSION: Transference of plain radiographs using a low cost/low resolution telemedicine link by A&E doctors is adequate for clinical interpretation.     

A computer-assisted monitoring system for arrhythmia detection in a medical intensive care unit

The arrhythmia detection capability of a computer-assisted monitoring system (CAMS) was studied in a large multidisciplinary ICU during an 18-month period. Four patient categories were evaluated: critically ill patients on mechanical volume respirators (group 1), patients with uncomplicated acute myocardial infarction (group 2), pacemaker-dependent patients (group 3), and patients on telemetry monitoring (group 4). ECG abnormalities were interpreted by the computer algorithm and recorded on paper. The same ECG abnormalities were analyzed independently by at least two critical care physicians unaware of the computer interpretations. The incidence of false-positive diagnoses (computer system errors) ranged from 10 in 1000 beats in groups 1, 2, and 4, to 20 in 1000 beats in group 3. Movement artifact accounted for 55.3% of all false-positive diagnoses. Of the total number of beats interpreted by the computer, 0.8% were false negatives and 3.8% were true positives. The most frequent true positive was pacemaker malfunction, which was diagnosed with 94% accuracy by the arrhythmia detection system. Significantly, rhythm abnormalities occurred as frequently in patients ventilated with mechanical respirators as in patients with acute myocardial infarction.     

Utility of supine oblique radiographs in detecting cervical spine injury

A retrospective case-control study was performed to determine if the addition of supine oblique radiographs to the routine cervical spine series results in the detection of patients with cervical spine injuries not identified with standard views alone. The cervical spine radiographs of 82 patients with known cervical spine injuries and 180 hospitalized patients without cervical spine injuries were collected. Radiographs of the two patient groups were randomly combined to form the study sample. The radiographs were reviewed independently by a board-certified radiologist and a board-certified emergency physician. During the first phase, each reviewer was provided with standard views of the cervical spine (lateral, anterior-posterior, open-mouth odontoid, and submental views). During the second phase, each reviewer was provided with the standard views and supine obliques. The reviewers were masked to all clinical information and previous radiologic interpretations. The results showed that in the first phase (standard views only), the two physicians had a sensitivity of 81% (95% confidence interval [CI] 74-87%) and a specificity of 93% (95% CI 90-96%). In the second phase (obliques included), the two physicians had a sensitivity of 76% (95% CI 69-83) and specificity of 90% (95% CI 87-93%). In a subset analysis of patients with posterior element (lamina, facet, and pedicle) fractures, the two physicians had a sensitivity of 88% (95% CI 78-95%) with standard radiographs and 86% (95% CI 76-94%) with the addition of oblique radiographs. In conclusion the addition of supine oblique radiographs to the standard trauma cervical spine series did not increase the readers' sensitivity for detecting patients with cervical spine injuries. Routinely including oblique radiographs in patients undergoing radiographic screening of the cervical spine is not warranted.     

Do pediatric intensivists and radiologists concur on the interpretation of chest radiographs?

BACKGROUND: Therapeutic decisions in the pediatric intensive care unit are made by pediatric intensivists (PI) based on their interpretation of chest radiographs before the formal interpretation by a pediatric radiologist (PR). This study was designed to determine the adequacy of chest radiograph interpretations by pediatric intensivists and the effects on patient care. The PI recorded their chest radiograph interpretations, documenting support devices and thoracic abnormalities. Concordance and discordance were determined by the pediatric pulmonologist who was not involved in the care of the patient by comparing the interpretations of the PI and PR. Clinically significant discordance was defined as interpretations by the radiologist that differed to those from the PI that may have required therapeutic intervention. RESULTS: The evaluation of 291 chest radiographs demonstrated an overall concordance rate of 82.5% (240 out of 291; P < 0.05). There was no significant difference in the ability of critical care medicine physicians to identify atelectasis, infiltrates, pleural effusions, or airleaks (P > 0.05). Support devices were correctly identified in 100% of the cases. Discordant interpretations included 20 that were clinically significant, 17 insignificant findings and 14 films over-interpreted by the PI. A chart review of the patients with discordant findings revealed only one finding that required an alteration in therapy. CONCLUSIONS: These findings demonstrate significant agreement between the interpretation of chest radiographs by PI and PR in selected clinical situations. These data support the current practice of the PI making therapeutic decisions based on their interpretations of chest radiographs.     

Are accident and emergency consultants as accurate as consultant radiologists in interpreting plain skeletal radiographs taken at a minor injury unit?

The objective of this study was to compare the accuracy of an accident and emergency (A&E) consultant in interpreting plain skeletal radiographs with that of a consultant radiologist (CR). It took the form of a retrospective study of 2133 radiographs taken in a Minor Injury Unit (MIU). A&E consultant reports on these films were compared with those of a CR and also with a gold standard. The A&E consultant diagnoses achieved an accuracy of 98.5% (CR 97.8%), sensitivity of 97.8% (CR 98.1%), specificity of 98.8% (CR 97.7%), positive predictive value of 97.3% (CR 95.1%) and negative predictive value of 98.97% (CR 99.07%) (gold standard of 100%). In conclusion, the A&E consultant reports of plain skeletal radiographs generated from an MIU were as accurate as those of a consultant radiologist. This could have significant implications for the wet reporting of A&E departmental radiographs.     

Spine problems in emergency department patients: Does every patient need an x-ray?

Two hundred adults with spine problems were evaluated by one examiner in a community hospital emergency department. A patient was considered to have a spine problem requiring evaluation if presenting with pain in the neck or back not obviously caused by a process outside of the spine (eg, back pain in a patient with renal colic); if there was known or suspected trauma to the neck or back; or if the clinical setting suggested spinal tumor, infection, metabolic bone disease, or ankylosing spondylitis. Of the 200 patients, 143 were studied by x-ray films. Six patients (6 of 143, or 4%) had x-ray abnormalities that mandated specific treatment. Fifty-two of the 57 patients not receiving x-ray studies were followed up at 2 months. Thirty-three of these patients (63%) had no x-ray studies interim and had improved greatly. Nineteen (37%) had been studied radiographically in the interim, but no abnormality requiring specific treatment was found in any patient. Emergency physicians should be aware that x-ray studies of the spine have low utility for patients whose histories and examinations are benign, that especially for women lumbosacral x-ray studies involve high gonadal radiation exposure, and that selected patients can be managed without x-ray studies and still be satisfied recipients of adequate medical care.     

What is the effect of reporting all emergency department radiographs?

Objectives: To evaluate the effect of formal radiological reporting of all emergency department (ED) radiographs on clinical practice and patient outcome, and to consider whether a selective reporting policy might prove safe and effective.

Methods: All radiographs taken in a single ED over a six month period were prospectively studied simultaneously in both the emergency and radiology departments to detect cases where a radiograph that was considered normal by ED staff was then reported as abnormal by the reporting radiologist. Whenever such a discrepancy occurred the patient's records were scrutinised to ascertain the source of the discrepancy, with a gold standard interpretation derived from senior clinical review and additional investigations where indicated. The clinical impact of the radiologist's formal report was then assessed. Accuracy of interpretation was considered in relation to the grade of ED staff and the radiographic examination obtained.

Results: During the study period, 19 468 new patient attendances to the ED generated 11 749 radiographic examinations. Discrepancies were detected in 175 patients (1.5% of all radiographic examinations). Of these, 136 (1.2%) were subsequently shown to have been incorrectly interpreted in the ED (ED false negatives), with 40 patients (0.3%) undergoing a change in management as a result. In the remaining 39 the ED interpretation was judged to be correct (radiology false positives), with 16 patients undergoing further investigations or visits to the ED to confirm this.

Conclusions: The formal reporting of ED radiographs by the radiology department detects a number of clinically important abnormalities that have been overlooked. However, this formal reporting also generates a number of incorrect interpretations that may lead to further unnecessary investigations. Some groups of ED radiographs (such as those interpreted by an ED consultant and films of the fingers and toes) may not require formal radiological reporting. The adoption of a selective reporting policy may reduce the reporting workload of the radiology department without compromising patient care.

     

The consistency of emergency physicians' and cardiologists' ECG interpretation and likelihood classification of chest pain patients

Patients presenting to the emergency department with chest pain are evaluated by emergency physicians in hospitals without cardiology cover 24 h a day. The purpose of this study is to determine the consistency of electrocardiography (ECG) interpretation and chest pain likelihood classification between emergency physicians and cardiologists. This randomised prospective cross-sectional study was performed in a tertiary care university hospital emergency department. The study form included ECG interpretation and chest pain likelihood classification according to American College of Cardiology (ACC)/American Heart Association (AHA) guideline which were recorded by emergency physicians and cardiologists separately in a blinded fashion. All chest pain patients who consulted with a cardiologist were enrolled into the study during the study period. The consistency between the two groups and the kappa value were calculated. Recorded study forms of 133 patients with cardiology consultations were evaluated. The consistency in the interpretation of ECG between the emergency physicians and cardiologists was found to be 94.6% (kappa = 0.85) for ST segment elevation, 78.6% (kappa = 0.57) for ischaemic ECG findings and 79.3% (kappa = 0.36) for dynamic ECG changes. The consistency for the likelihood classification between two groups for predicting the pain as angina or non-cardiac was 90.8% (kappa = 0.30), for classifying as acute coronary syndrome or stable angina pectoris (SAP) was 95.6% (kappa = 0.26) and for classifying patients as low likelihood or intermediate-high likelihood was 86.3% (kappa = 0.61). A strong consistency was shown between the emergency physicians' and cardiologists' ECG interpretation especially in determining the ST segment elevation. And also, there is a strong concordance in the likelihood classification of chest pain patients.     

Ability of emergency physicians with advanced echocardiographic experience at a single center to identify complex echocardiographic abnormalities

Objectives

To determine the ability of emergency physicians to detect complex abnormalities on point-of-care (POC) echocardiograms.

Methods

Single-blinded, nonrandomized, cross-sectional study. Twenty-five different emergency medicine clinical scenarios (video clips and digital images) covering a variety of echocardiographic abnormalities were presented to a group of emergency physician sonologists. The echocardiographic abnormalities included right ventricular dysfunction, left ventricular systolic dysfunction, diastolic dysfunction, regional wall motion abnormalities, Doppler abnormalities of pericardial tamponade physiology, left ventricular hypertrophy, hypertrophic cardiomyopathy, and aortic abnormalities. All emergency physician sonologists were blinded to the study hypothesis. They reviewed echocardiography video clips and images individually, and their interpretations were compared with the criterion standard (expert echocardiographer interpretations).

Results

A total of 200 echocardiography studies (video clips and images) were independently reviewed by 8 emergency physician sonologists with varying POC echocardiography experiences. Emergency physicians accurately identified left ventricular systolic dysfunction 94% of the time, diastolic dysfunction (100%), and right ventricular dysfunction 80% of the time. Regional wall motion abnormalities were detected only 50% of the time. Doppler echocardiographic abnormalities of pericardial tamponade physiology were accurately identified 57% of the time. Emergency physicians who performed more than 250 POC echocardiograms were found to be more accurate in identifying complex echocardiographic abnormalities.

Conclusions

Our study results suggest that with increased experience, emergency physicians can accurately identify most of complex echocardiographic abnormalities.