The imprecision of sonographic assessment of jugular venous distension among novice operators

Objective: To assess the precision of sonographic assessment of jugular venous distension (US-JVD). Methods: Sixteen emergency physicians underwent a short training in US-JVD comparable to a previously described training module. Then, they each performed US-JVD on three healthy individuals: Participant 1 with a "long, thin neck," Participant 2 with a "normal neck," and Participant 3 with a "short, thick neck." The criterion standard for US-JVD was the measurements by an expert sonographer who had previously performed 100 US-JVD exams. Results: There were a total of 48 US-JVD measurements. Twenty-five measurements were within 1cmH₂O of the criterion standard (52%). Ten out of 16 operators were within 1cmH₂O for Participant 1, as opposed to six of out 16 and nine of out 16 for Participants 2 and 3, respectively. The range of values was largest for Participant 2 (4-11cmH₂O) and smallest for Participant 3 (6-10cmH₂O). Five measurements (10%) were wrong, indicating abnormally low measurements consistent with hypovolemia. Conclusion: Physicians were the most precise while performing US-JVD on the participant with a "short, thick neck," and the least precise in the participant with a "normal neck." Ten percent of the measurements misidentified these healthy participants as having hypovolemia.