Variability in Interpretation of Cardiac Standstill Among Physician Sonographers
Variability in Interpretation of Cardiac Standstill Among Physician Sonographers
复制标题
DOI：
10.1016/j.annemergmed.2017.07.476
复制
发表时间：
2018-02-01
影响因子：
6.2
通讯作者：
Andrus, Phillip
中科院分区：
文献类型：
--
作者：
Hu, Kevin;Gupta, Nachi;Andrus, Phillip
研究目的：床旁超声心动图显示的心脏停顿作为心脏骤停预后的标志物已被广泛研究。据报道，在心脏停搏患者中，自主循环恢复的比例少至0%，多至45%。当明确记录时，这些研究中心脏活动的定义从心肌回声的任何轻微变化到任何动力学心脏活动。我们假设心脏活动的研究定义的可变性可能会影响心脏骤停患者视频剪辑的解释。本研究的目标是评估的变异性之间的停顿医师sonographers.Methods的解释：我们调查了医师sonographers在6次会议上举行的3个学术医疗中心在大纽约地区。调查受访者被分配20秒的幻灯片，以确定是否每15个视频剪辑的患者在心脏骤停停止或没有。数据收集匿名与射频remotes.Results：共有127名参与者，包括教师，研究员，和住院医师专门从事急诊医学，重症监护和心脏病学。所有参与者之间只有中等程度的评分者间一致性（α =0.47）。这种缺乏协议坚持跨专业，自我报告的培训水平，和自我报告的超声expertise.Conclusion：根据我们的研究结果，似乎有相当大的变异性之间的医生超声心动图医师的心脏停顿的解释。心脏活动和停顿的共识定义将提高心脏骤停超声研究的质量，并规范该技术在床边的使用。
Study objective: Cardiac standstill on point-of-care ultrasonography has been widely studied as a marker of prognosis in cardiac arrest. Return of spontaneous circulation has been reported in as few as 0% and as many as 45% of patients with cardiac standstill. When explicitly documented, the definition of cardiac activity in these studies varied from any slight change in echogenicity of the myocardium to any kinetic cardiac activity. We hypothesize that the variability in research definitions of cardiac activity may affect interpretation of video clips of patients in cardiac arrest. The goal of this study is to assess the variability in interpretation of standstill among physician sonographers.Methods: We surveyed physician sonographers at 6 conferences held at 3 academic medical centers in the Greater New York area. Survey respondents were allotted 20 seconds per slide to determine whether each of 15 video clips of patients in cardiac arrest were standstill or not. Data were collected anonymously with radio frequency remotes.Results: There were 127 total participants, including faculty, fellows, and resident physicians specializing in emergency medicine, critical care, and cardiology. There was only moderate interrater agreement among all participants (alpha=0.47). This lack of agreement persisted across specialties, self-reported training levels, and self-reported ultrasonographic expertise.Conclusion: According to the results of our study, there appears to be considerable variability in interpretation of cardiac standstill among physician sonographers. Consensus definitions of cardiac activity and standstill would improve the quality of cardiac arrest ultrasonographic research and standardize the use of this technology at the bedside.