Evaluation of a rapid bedside scoring system for microcirculation videos acquired from dogs.

OBJECTIVE: To appraise a novel scoring system (Bedside Evaluation of Microcirculation [BEM]) to provide qualitative and semiquantitative assessment of canine microcirculatory videos generated by sidestream dark field imaging. DESIGN: Prospective observational study. SETTING: University teaching hospital. ANIMALS: No animals were used in this study. Twenty microcirculatory videos (>20 s in length) acquired from the mucosa adjacent to the upper canine tooth of dogs were selected from a database of sidestream dark field microcirculatory videos with available current standard analysis (CSA). INTERVENTION: Three observers were trained to evaluate 5 video quality parameters (stability, content, illumination, focus, and pressure) and four perfusion parameters (total vessel density [TVD], capillary vessel density [CVD], perfused vessel density [PVD] and microvascular flow index [MFI]). Quality parameters were scored (excellent [0], sufficient [1], and insufficient [2]) similar to CSA recommendations. Each perfusion parameter was subjectively scored (1 lowest - 5 highest) using sample clips from the training video for comparison. Videos passed quality analysis if no parameter was scored insufficient. Repeatability and reproducibility were evaluated by assessing all films in a random order three times daily for 3 days. Strength of correlation of BEM with CSA for both qualitative and semiquantitative parameters was assessed. MEASUREMENTS AND MAIN RESULTS: The qualitative evaluation pass/fail assessment matched CSA 86% of the time with individual observer agreements of 84-88%. Agreement with CSA did not change significantly over the study period (84%, 88%, and 84% on days 1, 2, and 3, respectively). No significant correlations were demonstrated between any BEM perfusion parameter and the corresponding CSA values. CONCLUSIONS: Rapid bedside assessment of microcirculatory video quality can be achieved. However, semiquantitative analysis by BEM demonstrated a lack of correlation with CSA for any of the perfusion parameters assessed.