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Validation of Epworth Richmond’s Echocardiography Education Focused Year

Brooks, Kyle S. MBBS, FCICM, FACEM, DDU1; Tan, Li H. MB (Hons), BCh, BAO, FCARCSI, FCICM, DDU2; Rozen, Thomas H. MBBS, BmedSci, FRACP, FCICM, DDU3; Kelly, Di MBBS, FCICM4; McKenzie, Dean P. BA(Hons), PhD5; Calafiore, Paul MBBS, FRACP6; Barrett, Jonathan MBBS, FRACP, FCICM, MPH4

doi: 10.1097/CCM.0000000000004076
Online Clinical Investigation: PDF Only

Objectives: College of Intensive Care Medicine mandatory training in echocardiography requires a minimum 30 echocardiograms. Trainee echocardiography accuracy following mandatory training is unknown. Our objective was to determine the reliability of ICU trainee echocardiography after our yearlong College of Intensive Care Medicine accredited course.

Design: Single-center, prospective observational study. Trainee echocardiograms were compared to independent, blindedexpert echocardiograms, with a target of 37 matched scans per trainee.

Subjects: Trainees were eligible to participate on completion of our in-house, mandatory echocardiography training.

Setting: Epworth Richmond is in an Australian, private academic hospital with a critical care echocardiography teaching program.

Interventions: None.

Measurements and Main Results: Reliability was assessed on nine measurements. The primary outcome was agreement on left ventricular function; secondary outcomes included qualitative and quantitative assessments. Agreement was assessed using Cohen’s kappa, Fleiss-Cohen weighted kappa, Lin’s concordance correlation coefficient, or calculation of sensitivity and specificity as appropriate. Seven trainees performed a total of 270 matched scans. There was excellent agreement between experts and trainees for left ventricular function (Kappa, 0.86; 95% CI, 0.81–0.91). Secondary outcome measures (95% CI) were ventricular size ratio Kappa 0.76 (0.58–0.94), sensitivity 92.3% (64.0–99.8%), specificity 97.2% (94.9–99.1%), pericardial effusion Kappa 0.37 (0.13–0.60), sensitivity 33.3% (13.3–59.0%), specificity 97.6% (94.8–99.1%). Concordance coefficients (95% CI) for the remaining outcomes were left ventricular outflow tract velocity time integral 0.79 (0.74–0.84), left ventricular internal diameter in diastole 0.82 (0.78–0.86), left ventricular outflow tract diameter 0.61 (0.53–0.69), tricuspid annular plane systolic excursion 0.71 (0.64–0.78), tricuspid regurgitation maximum velocity 0.55 (0.44–0.65), and inferior vena cava diameter 0.60 (0.49–0.72).

Conclusions: ICU trainees showed very high overall agreement with experts on left ventricular function and substantial agreement for most secondary outcomes. This is the first study to assess echocardiography accuracy in Australian ICU trainees.

1Intensive Care Unit, Epworth HealthCare, University of Melbourne, Melbourne, VIC, Australia.

2Intensive Care Unit, Alfred Health, Melbourne, VIC, Australia.

3Intensive Care Unit, Murdoch Children’s Research Institute, Royal Children’s Hospital, University of Melbourne, Melbourne, VIC, Australia.

4Intensive Care Unit, Epworth HealthCare, Monash University, Melbourne, VIC, Australia.

5Department of Epidemiology and Preventive Medicine, Epworth Health-Care, Monash University, Melbourne, VIC, Australia.

6Cardiac Diagnostic Services, Epworth HealthCare, Richmond, VIC, Australia.

This work was performed at Epworth Richmond, 89 Bridge Rd, Richmond, 3121 Victoria, Australia.

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Supported, in part, by grant from the Epworth Research Institute which was used to employ sonographers for the research. No additional funding was required to run the teaching program which was delivered using existing nonclinical time from the consultant group.

Drs. Brooks’s and Barrett’s institutions received funding from Epworth Research Institute. Drs. Brooks and Kelly received support for article research from Epworth Research Institute. The remaining authors have disclosed that they do not have any potential conflicts of interest.

Trial registration: NCT02961439—

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