Don’t Get Your Signals Crossed: Preference Signaling in the 2023 Emergency Medicine Match

Background: Point of Care Echocardiography is frequently performed by Emergency Physicians (EPs) to guide patient care and make clinical decisions by evaluating left ventricular systolic function by calculating ejection fraction (EF).Objectives: The objective of this study is to compare EM residents' estimations of EF using various described techniques to patients' recent comprehensive echocardiograms (CE).Methods: This is an observational, prospective, cohort study to evaluate resident accuracy of estimation of EF using the methods of visual estimation (VE), fractional shortening (FS), and E-point septal separation (EPSS).Patients were enrolled at a Level 1 Trauma Center from September through December 2022, and inclusion criteria were patients who were admitted for chest pain or shortness of breath.VE was performed using estimation of change in LV diameter, myocardial thickening, and gross mitral valve excursion.VE was categorized as normal (>50%), mild/moderately depressed (30-50%), and severely depressed (<30%).FS and EPSS were calculated using M-mode in the standard fashion as previously described in the literature.Patients had CE within 3 months and results were compared with residents' findings.Data was analyzed using descriptive statistics and unweighted K.Results: VE was able to be obtained in 29, FS in 26, and EPSS in 25 patients.VE performed best with 83% accuracy compared to CE, with an unweighted K of 0.71 (95% CI 0.47-0.93).FS was 68% accurate compared to CE, with an unweighted K of 0.37 (95% CI 0.05-0.70).EPSS was 57% accurate compared to CE, with an unweighted K of 0.44 (95% CI 0.15-0.73).Of the three methods performed, 94% of EM residents believed visual inspection was the easiest.Residents were also surveyed on which method they thought to be most accurate, and the results were VE (37%), FS (31%), and EPSS (31%).Conclusions: VE of EF is easier to perform and is more accurate among novice learners, with better agreement with CE.