Design: Retrospective diagnostic accuracy cohort, single centre
Population: 194 emergency department patients with PE scanned by 97 emergency physicians
Primary outcome: Accuracy for right ventricular dysfunction versus consultative echocardiography
Effect: Sensitivity 76.8%, specificity 85.9%; kappa 0.63 (95% CI 0.51–0.75)

A retrospective single-centre study compared emergency physician point-of-care ultrasound with cardiologist-read echocardiography in 194 patients with confirmed pulmonary embolism, scanned by 97 different emergency physicians. Right ventricular dysfunction on the bedside scan meant a right ventricle larger than the left, reduced TAPSE, or both.

Against formal echo, the bedside scan was 77% sensitive and 86% specific, with moderate agreement (kappa 0.63). Accuracy was better when formal echo showed moderate to severe dysfunction.

In practice, a clearly dilated, poorly contracting right ventricle on bedside scan is a useful early marker in a patient with PE, and is most reliable in the cases that matter most. A normal bedside scan does not exclude milder dysfunction, so risk stratification still needs troponin, natriuretic peptide and formal imaging where available.

Look for a right ventricle larger than the left and reduced TAPSE on bedside scan in confirmed PE.
Treat obvious right ventricular dysfunction on bedside scan as a marker of higher risk while awaiting formal echo.
Do not rely on a normal bedside scan to classify PE as low risk.
Combine ultrasound findings with troponin, natriuretic peptide and clinical scores.

Why it matters

Bedside scanning can bring risk stratification forward, as long as its blind spots are known.

The statistics, in plain English

Sensitivity of 77% means about one in four cases of right ventricular dysfunction on formal echo were missed at the bedside. A kappa of 0.63 indicates moderate agreement beyond chance.