VEREEFY: Validation of Epworth Richmond's Echocardiography Education Focused Year.

Abstract

Introduction: The College of Intensive Care Medicine (CICM) has introduced mandatory training in echocardiography. Trainee echocardiography accuracy following mandatory training is unknown.

Objectives: Determine the reliability of ICU trainee echocardiography after our yearlong CICM accredited course.

Methods: Single-centre, prospective observational study of trainees in an Australian, private academic hospital. Trainees were eligible to participate on completion of our local echocardiography training. Trainee echocardiograms were compared to independent, blinded expert echocardiograms, with a target of 37 matched validation scans per trainee for statistical precision. The primary outcome was agreement on left ventricular (LV) 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.

Results: Seven trainees performed 266 scans. There was excellent agreement between experts and trainees for the primary outcome of LV function (Kappa 0.86, 95%CI=0.81-0.91) which was available on 266/266 scans. 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: LV outflow tract velocity time integral 0.80(0.74-0.84), LV internal diameter in diastole 0.82(0.78-0.86), LV 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 IVC diameter 0.60(0.49-0.72).

Conclusion(s): ICU trainees showed almost perfect overall agreement with experts on the primary outcome (LV function) and substantial agreement for most secondary outcomes. This is the first study to assess echocardiography accuracy in Australian ICU trainees.