- Design
- Retrospective diagnostic accuracy cohort
- Population
- 194 ED patients with PE scanned by 97 emergency physicians
- Primary outcome
- POCUS RV dysfunction vs cardiologist echocardiography
- Effect
- Sensitivity 76.8%, specificity 85.9%; kappa 0.63 (0.51–0.75)
This retrospective cohort, published in Annals of Emergency Medicine in June, included 194 emergency department patients with pulmonary embolism who had both an emergency physician point-of-care ultrasound and a cardiologist-reported echocardiogram. 97 different emergency physicians performed the scans. Right ventricular dysfunction on POCUS meant an RV larger than the LV, reduced TAPSE, or both.
Against formal echocardiography, POCUS was 76.8% sensitive and 85.9% specific, with 81.4% agreement (kappa 0.63, moderate). Accuracy was higher when the formal echo showed moderate to severe dysfunction. Agreement fell across stages of residency training, an unexpected finding that the design cannot explain.
In practice, a clearly dilated RV on bedside scan is useful early information for risk stratification, but a normal-looking RV does not exclude dysfunction — about one in four were missed. Formal assessment, troponin and natriuretic peptide still matter for intermediate-risk decisions.
- Treat a clearly dilated or poorly contracting RV on bedside scan as a sign of higher-risk PE.
- Do not use a normal bedside RV to rule out dysfunction; about a quarter were missed.
- Combine POCUS with troponin and natriuretic peptide for risk stratification.
- Arrange formal echocardiography when management depends on RV function.
Why it matters
Bedside RV findings increasingly drive early PE escalation decisions, and their limits need to be explicit.
Don't overread it
This was a retrospective selected cohort of patients who had both scans, which may overstate accuracy.
The statistics, in plain English
Sensitivity of 76.8% means about 23 of every 100 patients with RV dysfunction were read as normal on POCUS. A kappa of 0.63 indicates moderate agreement beyond chance, not interchangeable tests.
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