- Design
- Retrospective cohort, POCUS vs consultative echocardiography
- Population
- 194 emergency department patients with pulmonary embolism, 97 operators
- Primary outcome
- Accuracy of POCUS for right ventricular dysfunction
- Effect
- Sensitivity 76.8%, specificity 85.9%, agreement 81.4% (kappa 0.63, 95% CI 0.51 to 0.75)
This retrospective single-system cohort identified patients with pulmonary embolism who had both an emergency physician point-of-care ultrasound and a cardiologist-interpreted echocardiogram. It included 194 patients and 97 emergency physician operators.
Right ventricular dysfunction on point-of-care ultrasound was defined as a right ventricle larger than the left, reduced systolic function by tricuspid annular plane systolic excursion, or both. Compared with consultative echocardiography, it was 76.8% sensitive and 85.9% specific, with 81.4% agreement (kappa 0.63, 95% CI 0.51 to 0.75). Accuracy was better when consultative echo showed moderate to severe dysfunction. Inter-rater reliability declined through residency training.
Patients who had both tests were probably sicker or higher risk, so accuracy might differ in an unselected population. A negative bedside result should not reassure on its own.
- A negative point-of-care ultrasound does not exclude right ventricular dysfunction; about one in four cases was missed.
- Accuracy improved when dysfunction was moderate to severe.
- Request formal echocardiography when PE risk stratification depends on right ventricular status.
- Training level affected agreement; supervise early learners.
Why it matters
It sets the limits of a bedside tool that guides decisions about thrombolysis and admission.
Don't overread it
Retrospective selection of patients who had both tests may inflate or deflate accuracy.
The statistics, in plain English
Sensitivity of 76.8% means about 23 in 100 patients with dysfunction were missed. A kappa of 0.63 is moderate agreement: better than chance but not interchangeable.
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