What are the minimum requirements to establish proficiency in lung ultrasound training for quantifying B‐lines?

ESC Heart Failure

George J. Eckert¹  Frances M. Russell²  Peter S. Pang²  Robinson Ferre²  Vicki Noble³  Sean P. Collins⁴  Phillip D. Levy⁵  Robert R. Ehrman⁵  Katarina L. Fabre⁶  Luna Gargani⁷ 

[1] Department of Biostatistics Indiana University School of Medicine Indianapolis IN USA;Department of Emergency Medicine Indiana University School of Medicine Indianapolis IN USA;Department of Emergency Medicine University Hospitals Cleveland Medical Center Cleveland OH USA;Department of Emergency Medicine Vanderbilt University Medical Center Nashville TN USA;Department of Emergency Medicine Wayne State University School of Medicine Detroit MI USA;Indiana University School of Medicine Indianapolis IN USA;Institute of Clinical Physiology National Research Council Pisa Italy;

关键词: Heart failure;    Lung ultrasound;    B‐lines;    Proficiency;    Learning curves;   

DOI  :  10.1002/ehf2.12907

来源: DOAJ

【 摘 要 】

Abstract Aims The goal of this study was to determine the number of scans needed for novice learners to attain proficiency in B‐line quantification compared with expert interpretation. Methods and results This was a prospective, multicentre observational study of novice learners, physicians and non‐physicians from three academic institutions. Learners received a 2 h lung ultrasound (LUS) training session on B‐line assessment, including lecture, video review to practice counting and hands‐on patient scanning. Learners quantified B‐lines using an eight‐zone scanning protocol in patients with suspected acute heart failure. Ultrasound (US) machine settings were standardized to a depth of 18 cm and clip length of 6 s, and tissue harmonics and multibeam former were deactivated. For quantification, the intercostal space with the greatest number of B‐lines within each zone was used for scoring. Each zone was given a score of 0–20 based on the maximum number of B‐lines counted during one respiratory cycle. The B‐line score was determined by multiplying the percentage of the intercostal space filled with B‐lines by 20. We compared learner B‐line counts with a blinded expert reviewer (five US fellowship‐trained faculty with > 5 years of clinical experience) for each lung zone scanned; proficiency was defined as an intraclass correlation of > 0.7. Learning curves for each learner were constructed using cumulative sum method for statistical analysis. The Wilcoxon rank‐sum test was used to compare the number of scans required to reach proficiency between different learner types. Twenty‐nine learners (21 research associates, 5 residents and 3 non‐US‐trained emergency medicine faculty) scanned 2629 lung zones with acute pulmonary oedema. After a mean of 10.8 (standard deviation 14.0) LUS zones scanned, learners reached the predefined proficiency standard. The number of scanned zones required to reach proficiency was not significantly different between physicians and non‐physicians (P = 0.26), learners with no prior US experience vs. > 25 prior patient scans (P = 0.64) and no prior vs. some prior LUS experience (P = 0.59). The overall intraclass correlation for agreement between learners and experts was 0.74 and 0.80 between experts. Conclusions Our results show that after a short, structured training, novice learners are able to achieve proficiency for quantifying B‐lines on LUS after scanning 11 zones. These findings support the use of LUS for B‐line quantification by non‐physicians in clinical and research applications.

【 授权许可】

Unknown