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Open Access 01-02-2019 | Care | Original

The diagnostic accuracy of clinical examination for estimating cardiac index in critically ill patients: the Simple Intensive Care Studies-I

Authors: Bart Hiemstra, Geert Koster, Renske Wiersema, Yoran M. Hummel, Pim van der Harst, Harold Snieder, Ruben J. Eck, Thomas Kaufmann, Thomas W. L. Scheeren, Anders Perner, Jørn Wetterslev, Anne Marie G. A. de Smet, Frederik Keus, Iwan C. C. van der Horst, SICS Study Group

Published in: Intensive Care Medicine | Issue 2/2019

Abstract

Purpose

Clinical examination is often the first step to diagnose shock and estimate cardiac index. In the Simple Intensive Care Studies-I, we assessed the association and diagnostic performance of clinical signs for estimation of cardiac index in critically ill patients.

Methods

In this prospective, single-centre cohort study, we included all acutely ill patients admitted to the ICU and expected to stay > 24 h. We conducted a protocolised clinical examination of 19 clinical signs followed by critical care ultrasonography for cardiac index measurement. Clinical signs were associated with cardiac index and a low cardiac index (< 2.2 L min⁻¹ m²) in multivariable analyses. Diagnostic test accuracies were also assessed.

Results

We included 1075 patients, of whom 783 (73%) had a validated cardiac index measurement. In multivariable regression, respiratory rate, heart rate and rhythm, systolic and diastolic blood pressure, central-to-peripheral temperature difference, and capillary refill time were statistically independently associated with cardiac index, with an overall R² of 0.30 (98.5% CI 0.25–0.35). A low cardiac index was observed in 280 (36%) patients. Sensitivities and positive and negative predictive values were below 90% for all signs. Specificities above 90% were observed only for 110/280 patients, who had atrial fibrillation, systolic blood pressures < 90 mmHg, altered consciousness, capillary refill times > 4.5 s, or skin mottling over the knee.

Conclusions

Seven out of 19 clinical examination findings were independently associated with cardiac index. For estimation of cardiac index, clinical examination was found to be insufficient in multivariable analyses and in diagnostic accuracy tests. Additional measurements such as critical care ultrasonography remain necessary.

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Title: The diagnostic accuracy of clinical examination for estimating cardiac index in critically ill patients: the Simple Intensive Care Studies-I
Authors: Bart Hiemstra
Geert Koster
Renske Wiersema
Yoran M. Hummel
Pim van der Harst
Harold Snieder
Ruben J. Eck
Thomas Kaufmann
Thomas W. L. Scheeren
Anders Perner
Jørn Wetterslev
Anne Marie G. A. de Smet
Frederik Keus
Iwan C. C. van der Horst
SICS Study Group
Publication date: 01-02-2019
Publisher: Springer Berlin Heidelberg
Keyword: Care
Published in: Intensive Care Medicine / Issue 2/2019
Print ISSN: 0342-4642
Electronic ISSN: 1432-1238
DOI: https://doi.org/10.1007/s00134-019-05527-y

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

The diagnostic accuracy of clinical examination for estimating cardiac index in critically ill patients: the Simple Intensive Care Studies-I

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on sleep in brain health

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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