379 Reliability of Cardiopulmonary Ultrasound Interpretation During Resuscitation of Patients with Suspected Septic Shock

Emergency medicine (EM) clinicians who care for critically ill patients often make clinical decisions with relatively little information. Patients with septic shock in particular pose a challenge as they frequently require several time-sensitive decisions. Point-of-care cardiopulmonary ultrasound (CPUS) has emerged as a promising, rapidly available test to assess patient volume and respiratory status to guide interventions. The purpose of this study is to assess the reliability of real-time clinician interpretation of CPUS findings. We performed a prospective, observational, pilot study enrolling patients with hypotension (systolic blood pressure <90) and clinician suspected infection. Clinicians performed a focused CPUS and recorded their interpretation on a data entry form. Two ultrasound fellowship trained physicians recorded an "expert" interpretation of the recorded images. Disagreement between the two experts were resolved in a consensus conference by the study team, and the final expert consensus agreement was compared to the recorded clinician interpretation. Cardiac variables included left ventricular systolic function (LVF), right ventricular (RV) function, RV size. Lung ultrasound (LUS) was interpreted for absence of B-lines and presence of unilateral or bilateral B-lines. We enrolled 51 patients. Cohen's kappa interrater coefficient and percent agreement are shown in Table 1. LUS showed the highest agreement between expert and clinician, Cohen's kappa = 0.73 (95% CI: 0.51 to 0.95), indicating substantial agreement. RV function showed very poor agreement, Cohen's kappa = -0.05 (95% CI: -0.6 to 0.5). Interpretation of LV function and RV size demonstrated fair to moderate agreement, Cohen's kappa = 0.37 (95% CI: 0.1 to 0.64) and 0.47 (95% CI: 0.07 to 0.88). LUS findings exhibit the highest reliability when interpreted by clinicians compared to expert reviewer. Care must be exercised when interpreting CPUS variables in an acute setting, especially with respect to cardiac findings. Further work is needed to understand patient- and sonographer-specific variables which may contribute to unreliable CPUS interpretation.