Accuracy of Medical Student Measurements of CT Right-to-Left Ventricular Diameter in Patients with Acute Pulmonary Embolism

Author:

Durant Edward J.12ORCID,Fetterolf Sarah M.3,Engelhart Darcy C.3,Farshidpour Leyla S.4,Shan Judy5,Hung Yun-Yi6,Chang Joshua C.7,Roudsari Bahman S.2,Vinson David R.26

Affiliation:

1. Kaiser Permanente, Bernard J. Tyson School of Medicine, CA, USA

2. The Permanente Medical Group, Oakland, CA, USA

3. California Northstate University, College of Medicine, CA, USA

4. University of California, Davis School of Medicine, CA, USA

5. University of California, San Francisco School of Medicine, CA, USA

6. Kaiser Permanente Northern California, Division of Research, CA, USA

7. Internal Medicine Residency Program, Kaiser Foundation Health Plan Inc, CA, USA

Abstract

Objectives: Acute pulmonary embolism (PE) is a common disease, necessitating risk stratification to determine management. A right ventricle (RV) to left ventricle (LV) diameter ratio ≥1.0 on computed tomography pulmonary angiography (CTPA) suggests RV strain, which may indicate a worse prognosis. Two prior studies showed that residents with brief training by a radiologist could accurately measure RV/LV ratio. We assessed whether medical students could accurately measure RV dilatation. Methods: We conducted a post hoc analysis of a retrospective cohort study of adults undergoing management for acute PE at 21 community emergency departments across Kaiser Permanente Northern California from 2013 to 2015. We created a sample, stratified to contain an equal number of patients from each of the 5 PE Severity Index classes. Four medical students measured RV and LV diameter on CTPA after training from an emergency medicine physician and an interventional radiologist. We used Cohen's kappa statistics, Bland-Altman plots, and Pearson correlation coefficients to assess interrater reliability. Results: Of the 108 CTPAs reviewed, 79 (73%) showed RV dilatation and 29 (27%) did not. The kappa statistic for the presence of RV dilatation of the medical students compared to the radiologist showed moderate agreement for 3 medical students (kappa (95% CI): 0.46 (0.21-0.70), 0.49 (0.31-0.68), 0.50 (0.32-0.68)) and fair agreement for 1 medical student (kappa (95% CI): 0.29 (0.10-0.47)). The average interrater differences in RV/LV ratio between a radiologist and each of the 4 medical students were −0.04, −0.05, 0.04, and 0.24. Pearson correlation coefficients were 0.87, 0.80, 0.74, and 0.78, respectively, indicating moderate correlation ( P < .001 for all). Conclusion: Medical students were able to identify RV dilatation on CTPA in moderate agreement with that of a radiologist. Further study is needed to determine whether medical student accuracy could improve with additional training.

Funder

Kaiser Permanente

Publisher

SAGE Publications

Subject

General Medicine

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