Agreement With Pediatric Suprapatellar Bursa Effusion Assessments by Point-of-Care Ultrasound After Remote Training

Abstract

Background:The ease of instruction for point-of-care ultrasound (POCUS) to detect suprapatellar bursa (SPB) effusions in pediatric patients is unknown. Considering in person limitations because of the coronavirus pandemic, strategies for POCUS education by remote learning are necessary. Methods:We crafted a 90-minute didactic training that was presented via a remote learning format. The main outcome of interest was the interobserver reliability of SPB effusion assessment by novice sonologists compared with POCUS faculty. Novice sonologists were pediatric emergency medicine (PEM) fellows. Pediatric emergency medicine fellows interpreted longitudinal SPB examinations obtained in our pediatric emergency department from July 2013 to June 2020. Assessments were performed 2 months after the remote training. Pediatric emergency medicine fellows had a limited experience performing these musculoskeletal scans and were blinded to POCUS faculty and each other's assessments. Interobserver reliability was assessed with Cohen κ coefficient. Second, we calculated test characteristics of knee radiography compared with PEM POCUS faculty determination of SPB effusion by ultrasound. We further explored how effusion size measured by POCUS impacted the diagnosis by knee radiography. A receiver operator characteristic curve of knee radiography diagnosis of SPB effusion was created using the maximal height of SPB effusion by POCUS as the predictor variable.Results: A total of 116 SPB scans in 71 patients were assessed. From this group, 70 scans were of affected knees and 46 scans were of contralateral, asymptomatic knees. The mean age of patients was 10 years and 46% were girl. The prevalence of SPB effusions was 42%. The κ coefficients between the 3 novice sonologists and POCUS faculty were 0.75 (0.62-0.87), 0.77 (0.65-0.89), and 0.83 (0.72-0.93) with 88%, 89%, and 91% agreement. Knee radiography exhibited an overall sensitivity of 65% (95% confidence interval [CI], 46-79%), specificity of 84% (95% CI, 60-97%), negative predictive value of 55% (95% CI, 43-66%), and positive predictive value of 88% (95% CI, 73-96%) to diagnose SPB effusions. The area under the receiver operator characteristic curve was 0.850. With an SPB height cutoff of 4 mm as true positives, radiography had a sensitivity of 81% and a specificity of 83%.Conclusions: After a remote teleconference didactic session, PEM fellows were able to successfully diagnose SPB effusions using a longitudinal view with substantial interobserver reliability. Knee radiography exhibited limited sensitivity to rule out SPB effusions.

Procedures for the content, conduct and format of EULAR/PReS paediatric musculoskeletal ultrasound courses

“…[38][39][40][41][42][43] All levels of PedMSUS should be residential; however, since the Delphi surveys were performed just at the initial stages of the COVID-19 pandemic, other education tools (introductory webinars, focused online courses), though proposed in the initial questionnaires, might not have been taken into the same consideration they may deserve now. 44 The Consensus group also showed agreement in organising PedMSUS courses just prior the EULAR or the PReS or the joined EULAR/PReS Meetings, likely due to the dampening of expenses in joined events.…”

Can you teach a hands-on skill online? A scoping review of e-learning for point-of-care ultrasound in medical education

“… Knowledge, image acquisition K1 and K2 Worse image acquisition skills for e-learning group Platz et al, 2011, 41 USA, Prospective educational study Emergency Medicine and surgery residents ( n = 44) E-FAST Computer group listened to narrated lectures on desktop computers with headphones. Classroom group with traditional lecture Image interpretation K2 Worse image interpretation skills for e- learning group (in those with previous US experience) Riera et al, 2021, 49 USA, Cross-sectional study Pediatric emergency medicine fellows ( n = 3) MSK (suprapatellar bursa effusions) 90-minute didactic training that was presented via a remote learning format POCUS faculty (used as gold standard) Image interpretation K2 Good inter-rater reliability after e-learning Zavitz et al, 2021, 15 USA, Description of educational innovation Medical students ( n = 141) Multiple (not specified) 10 day virtual course including live scanning demonstrations and practicing ultrasound probe maneuvers using a cellphone N/A Image interpretation K2 Improvement in scores after e-learning Table 1C: Studies examining online asynchronous learning for POCUS in medical education Author, publication date, country, study design Participants Content Intervention Comparison Outc...…”