Reliability and Reproducibility of the Venous Excess Ultrasound (VExUS) Score, A Multi-Site Prospective Study Validating a Novel Ultrasound Technique for Comprehensive Assessment of Volume Status

Though the novel Venous Excess Ultrasound (VExUS) score is increasingly used as a noninvasive ultrasonographic method to measure venous congestion, the inter-rater reliability (IRR) and inter-user reproducibility (IUR) of this procedure have not been established. For this reason, we conducted a multi-site study of the IRR and IUR of the VExUS score between a wide range of physicians, reporting the Kappa statistic (KS) and Intraclass Correlation Coefficient (ICC) for IRR and IUR. We found that when VExUS images were interpreted by physicians specializing in cardiology, pulmonology, hospital medicine, and emergency medicine, there was substantial IRR, with a KS of 0.71 and ICC of 0.83 for the overall VExUS grade (p < 0.001), and IUR, with a KS 0.63 and ICC of 0.8, suggesting that the VExUS score is likely to be a reliable and reproducible measure interpretable by clinicians with diverse backgrounds.