(1533) On a Scale From 1 to 10, How Bad Is Your RV Failure? A New Scale to Qualify the Degree of RV Failure

Introduction: Point of care ultrasound (POCUS) assessment of right ventricular failure (RVF) in acute pulmonary embolism (PE) is challenging to qualify. Current quantitative techniques are highly operator-dependent and may inaccurately reflect true RVF. Developing a qualitative scale could more accurately describe the degree of RVF and allow for clearer inter-professional communication for management of acute RVF due to PE. We sought to create and validate a ten-point scale to qualify the degree of RV failure on POCUS in patients with large PEs.

Methods: A ten-point scale infographic depicting worsening RVF was created. POCUS of patients with varying degrees of RVF from PEs were collected and graded on this 10-point RVF scale by a pulmonary hypertension cardiologist who was used as the gold standard. A REDCAP survey was distributed with three teaching questions to give examples of the RV scale results and reasoning and followed by ten response test questions. Respondents were from emergency medicine, critical care, cardiology, and internal medicine.

Results: 28 respondents completed the survey: 5 cardiologists, 6 intensivists, 12 emergency physicians, and 5 internists. The results showed that there was poor inter-operator reliability in applying the scale. Cardiology was most precise (average of 3.5 points deviation from gold standard) while internal medicine (avg. 3.9 points), critical care (avg. 3.5 although significant heterogeneity), and emergency medicine (avg. 3.3 although significant heterogeneity) were neither precise nor accurate. Respondents performed a self-assessment of their skill and it was compared to their RV severity assessment. Although the correlation of 0.227 (95% CI: -0.159, 0.553) was not statistically significant, it suggested those who rate themselves more highly actually performed worse on assessing RVF. There was greater error amongst respondents with more severe cases of RVF than less severe (p = 0.296, CI: 0.136, 0.457).

Conclusions: Assessment of RVF in acute PE is a critical skill to guide management and therapeutic interventions. Implementation of a qualitative scale with increased multidisciplinary usage can allow for better interprofessional communication regarding treating massive PE. Further multicenter trials are required to further validate the ten-point RVF scale.