title: The inability of emergency physicians to adequately clinically estimate the underlying hemodynamic profiles of acutely ill patients.
abstract: OBJECTIVE
  Emergency physicians (EPs) estimate the underlying hemodynamics of acutely ill patients and use them to help both diagnose and formulate a treatment plan. This trial compared the EP clinically derived estimates of cardiac output (CO) and systemic vascular resistance (SVR) to those measured noninvasively.
  
  
  METHODS
  Forty acutely ill emergency department patients with a broad range of diagnosis and blood pressure (BP) and pulse were monitored for 2 hours using novel noninvasive finger cuff technology (Nexfin; BMEYE, Amsterdam, The Netherlands). The Nexfin device provides continuous BP monitoring and, from the resulting pulse pressure waveform, calculates beat-to-beat CO and SVR. At baseline assessment and after 2 hours of testing and therapy, treating EPs were asked to estimate the CO and SVR (low, normal, or high), and these were compared with Nexfin measurements.
  
  
  RESULTS
  Twenty-five men and 15 women were enrolled with a mean age of 62.2 years (SD, 12.6 years). Eighteen had acute shortness of breath; 11, with probable stroke syndrome; 3, with suspected sepsis; and 8, with a systolic BP greater than 180 or less than 100 mm Hg. Concordance tables showed that there was very little agreement (κ values) between either the compared initial CO (-0.0873) and SVR (-0.0645) or the 2-hour values (-0.0645 and -0.1949, respectively).
  
  
  CONCLUSIONS
  Emergency physicians cannot accurately estimate the underlying hemodynamic profiles of acutely ill patients when compared with more objective measurements. This inaccuracy may have important clinical ramifications. Further study is needed to determine how to use these measured continuous CO and SVR monitoring values.
authors.affiliation: Department of Emergency Medicine, Henry Ford Health System, Detroit, MI 48202, USA. rnowak1@hfhs.org
authors.forename: Richard M
authors.initials: RM
authors.lastname: Nowak
authors.forename: Ayan
authors.initials: A
authors.lastname: Sen
authors.forename: Audwin J
authors.initials: AJ
authors.lastname: Garcia
authors.forename: Heidi
authors.initials: H
authors.lastname: Wilkie
authors.forename: James J
authors.initials: JJ
authors.lastname: Yang
authors.forename: Michael R
authors.initials: MR
authors.lastname: Nowak
authors.forename: Michele L
authors.initials: ML
authors.lastname: Moyer
mesh_terms: D001794:Blood Pressure / Q000502:physiology; D002302:Cardiac Output / Q000502:physiology; D016638:Critical Illness; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008991:Monitoring, Physiologic; D011446:Prospective Studies; D014655:Vascular Resistance / Q000502:physiology