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Can emergency medicine residents diagnose neurogenic stunned myocardium in the emergency department by Focused Assessment Diagnostic Echocardiography?
Can emergency medicine residents diagnose neurogenic stunned myocardium in the emergency department by Focused Assessment Diagnostic Echocardiography?
- Source :
- Critical Care & Shock; 2020, Vol. 23 Issue 2, p76-84, 9p, 1 Diagram, 3 Charts, 1 Graph
- Publication Year :
- 2020
-
Abstract
- Purpose: To assess the ability of trained emergency medicine (EM) residents to diagnose neurogenic stunned myocardium (NSM) in patients with acute intracranial events in the emergency department (ED) using the Focused Assessment diagnostic Echocardiography (FADE). Methods: This prospective cross-sectional study was conducted between February 2018 and January 2019. First, four postgraduate year-3 (PGY-3) EM residents were trained through participation in 10 hours of theoretical FADE education and 20 hands-on FADE on ED patients. Then, adult patients (aged over 18 years old) with acute cerebrovascular accidents (CVAs) were enrolled in the study. Patients with a history of prior cardiac disease, concurrent CVA and ST-elevation myocardial infarction (STEMI), and cardiopulmonary arrest in the ED were excluded. The results of echocardiography by the cardiologists were considered as the gold standard. Results: Eighty-five cases were enrolled in the final analysis. The mean age of participants was 62.7 years, and 47 (55.3%) were male. There was a good agreement between the EM residents and cardiologists in diagnosing left ventricular (LV) dysfunction (Cohen's Kappa=0.7, 95%CI=0.65-0.8). Troponin I was positive in 3 (3.5%) patients. Based on the diagnosis of cardiologists, all three patients had heart failure and received a definitive diagnosis of NSM. Whereas, according to the FADE exam by EM residents, 2 out of 3 cases with positive enzyme had heart failure (interrater agreement= 66.6%). Conclusion: Our study showed that trained EM residents could use the FADE exam to diagnose the NSM in CVA patients in the ED. [ABSTRACT FROM AUTHOR]
- Subjects :
- MYOCARDIAL infarction diagnosis
HEART ventricle diseases
CARDIOLOGISTS
CEREBROVASCULAR disease
CONFIDENCE intervals
ELECTROCARDIOGRAPHY
EMERGENCY medicine
LEFT heart ventricle
HOSPITAL emergency services
HOSPITAL medical staff
LONGITUDINAL method
STROKE
INTER-observer reliability
NATIONAL competency-based educational tests
CROSS-sectional method
ACUTE diseases
TROPONIN
DESCRIPTIVE statistics
DISEASE complications
Subjects
Details
- Language :
- English
- ISSN :
- 14107767
- Volume :
- 23
- Issue :
- 2
- Database :
- Supplemental Index
- Journal :
- Critical Care & Shock
- Publication Type :
- Academic Journal
- Accession number :
- 142733914