Bedside echocardiography by emergency physicians

Study objective: Timely diagnosis of a pericardial effusion is often critic al in the emergency medicine setting, and echocardiography provides the onl y reliable method of diagnosis at the bedside. We attempt to determine the accuracy of bedside echocardiography as performed by emergency physicians t o detect pericardial effusions in a variety of high-risk populations. Methods: Emergency patients presenting with high-risk criteria for the diag nosis of pericardial effusion underwent emergency bedside 2-dimensional ech ocardiography by emergency physicians who were trained in ultrasonography. The presence or absence of a pericardial effusion was determined, and all i mages were captured on video or as thermal images. All emergency echocardio grams were subsequently reviewed by the Department of Cardiology for the pr esence of a pericardial effusion. Results: During the study period, a total of 515 patients at high risk were enrolled. Of these, 103 patients were ultimately deemed to have a pericard ial effusion according to the comparative standard. Emergency physicians de tected pericardial effusion with a sensitivity of 96% (95% confidence inter val [CI] 90.4% to 98.9%), specificity of 98% (95% Cl 95.8% to 99.1%), and o verall accuracy of 97.5% (95% Cl 95.7% to 98.7%). Conclusion: Echocardiography performed by emergency physicians is reliable in evaluating for pericardial effusions; this bedside diagnostic tool may b e used to examine specific patients at high risk. Emergency departments inc orporating bedside ultrasonography should teach focused echocardiography to evaluate the pericardium.