# Reliability and reproducibility of the venous excess ultrasound (VExUS) score, a multi-site prospective study: validating a novel ultrasound technique for comprehensive assessment of venous congestion

## TL;DR

This study validates a new ultrasound technique called VExUS for measuring venous congestion, showing it is reliable and reproducible across different clinicians.

## Contribution

The study evaluates the reliability and reproducibility of VExUS with and without ECG, demonstrating its potential for diverse clinical use.

## Key findings

- VExUS showed substantial inter-rater reliability with a Kappa statistic of 0.71 and ICC of 0.83.
- Inter-user reproducibility was also substantial, with a Kappa of 0.63 and ICC of 0.8.
- ECG-augmented VExUS images showed greater agreement among raters.

## Abstract

Though the novel venous excess ultrasound (VExUS) score is increasingly used as a noninvasive means of venous congestion measurement, the inter-rater reliability (IRR), inter-user reproducibility (IUR), and utility of concurrent ECG have not been evaluated. We conducted a multicenter study of the IRR, IUR, and utility of ECG for VExUS interpretation between four attending physicians of diverse specialties, reporting the Kappa statistic (KS) and Intraclass Correlation Coefficient (ICC) for IRR and IUR for scans with and without ECG. Eighty-four paired VExUS exams from 42 patients, 60 of which had a concurrent ECG tracing, were interpreted. They showed 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. There was greater agreement among images with an ECG tracing. These results suggest that ECG-augmented VExUS may be a reliable and reproducible measure interpretable by clinicians with diverse backgrounds.