title: Ability of emergency physicians with advanced echocardiographic experience at a single center to identify complex echocardiographic abnormalities.
abstract: OBJECTIVE
  To determine the ability of emergency physicians to detect complex abnormalities on point-of-care (POC) echocardiograms.
  
  
  METHODS
  Single-blinded, nonrandomized, cross-sectional study. Twenty-five different emergency medicine clinical scenarios (video clips and digital images) covering a variety of echocardiographic abnormalities were presented to a group of emergency physician sonologists. The echocardiographic abnormalities included right ventricular dysfunction, left ventricular systolic dysfunction, diastolic dysfunction, regional wall motion abnormalities, Doppler abnormalities of pericardial tamponade physiology, left ventricular hypertrophy, hypertrophic cardiomyopathy, and aortic abnormalities. All emergency physician sonologists were blinded to the study hypothesis. They reviewed echocardiography video clips and images individually, and their interpretations were compared with the criterion standard (expert echocardiographer interpretations).
  
  
  RESULTS
  A total of 200 echocardiography studies (video clips and images) were independently reviewed by 8 emergency physician sonologists with varying POC echocardiography experiences. Emergency physicians accurately identified left ventricular systolic dysfunction 94% of the time, diastolic dysfunction (100%), and right ventricular dysfunction 80% of the time. Regional wall motion abnormalities were detected only 50% of the time. Doppler echocardiographic abnormalities of pericardial tamponade physiology were accurately identified 57% of the time. Emergency physicians who performed more than 250 POC echocardiograms were found to be more accurate in identifying complex echocardiographic abnormalities.
  
  
  CONCLUSIONS
  Our study results suggest that with increased experience, emergency physicians can accurately identify most of complex echocardiographic abnormalities.
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ. Electronic address: sriadhikari@aol.com.
authors.forename: Srikar
authors.initials: S
authors.lastname: Adhikari
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Albert
authors.initials: A
authors.lastname: Fiorello
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Lori
authors.initials: L
authors.lastname: Stolz
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Travis
authors.initials: T
authors.lastname: Jones
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Richard
authors.initials: R
authors.lastname: Amini
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Austin
authors.initials: A
authors.lastname: Gross
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Kathleen
authors.initials: K
authors.lastname: O'Brien
authors.affiliation: Department of Emergency Medicine, University of Arizona Medical Center, Tucson, AZ.
authors.forename: Jarrod
authors.initials: J
authors.lastname: Mosier
authors.affiliation: Department of Internal Medicine, University of South Carolina School of Medicine, Columbia, SC.
authors.forename: Michael
authors.initials: M
authors.lastname: Blaivas
mesh_terms: D002983:Clinical Competence; D003430:Cross-Sectional Studies; D004452:Echocardiography / Q000592:standards*; D004635:Emergency Medicine / Q000592:standards*; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D019095:Point-of-Care Systems; D016037:Single-Blind Method