Longitudinal accuracy analysis of ultrasound performed during a four‐year emergency medicine residency

Schleifer, Jessica; Haney, Rachel M.; Shokoohi, Hamid; Huang, Calvin; Ratanski, Daniel; Kimberly, Heidi H.; Liteplo, Andrew S.

doi:10.1002/aet2.10574

Cited by 5 publications

(4 citation statements)

References 15 publications

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“…Indeed, an insufficient number of peer-reviewed ultrasound examinations could prevent trainees in the STS group to reach interpretation plateau for each imaging spot 33 . Schleifer et al 34 also showed that POCUS usage decreased over the residency as well as accuracy to the diagnosis if not maintained by additional educational initiatives such as refresher rotations. This is a pivotal fact, in particular when certification is not part of the curriculum 35 .…”

Section: Discussionmentioning

confidence: 99%

Impact of Different Training Methods on Daily Use of Point-of-Care Ultrasound

De Carvalho,

Godiveaux,

Javaudin

et al. 2023

Ultrasound Quarterly

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Point-of-care ultrasound (POCUS) curriculum varies among countries. However, the length of training required for physicians is still under debate. We investigated the impact of different training methods: short hands-on courses (STS), long academic training sessions (LTS), or both (mixed training [MTS]), for POCUS daily use and self-reported confidence overall and specific to specific clinical situations. This was a descriptive study conducted over a 3-month period through a Web-based survey designed to assess the influence of different methods of POCUS training among physicians and residents on their daily practice. The survey was sent to 1212 emergency physicians with prior POCUS training; 515 answers (42%) could be analyzed. Participants in the STS group performed POCUS less frequently than physicians in the LTS or MTS group. Daily use in the STS group was 51% versus 82% in the LTS group and 83% in the MTS group (P < 0.01). The overall self-reported confidence in POCUS was lower in the STS group (P < 0.01) in all studied clinical situations. There was no significant difference between LTS and MTS groups (P > 0.05). Method of POCUS training significantly influenced POCUS daily use. Physicians who underwent long training sessions used POCUS more frequently in their routine practice and were significantly more confident in their ability to perform and interpret a POCUS examination.

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Section: Discussionmentioning

confidence: 99%

Impact of Different Training Methods on Daily Use of Point-of-Care Ultrasound

De Carvalho,

Godiveaux,

Javaudin

et al. 2023

Ultrasound Quarterly

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“…Also, we found that not all studies evaluating HINTS were in AVS and maintain proficiency at HINTS, STANDING algorithm, VOG, etc. [92][93][94] ; understanding cognitive biases that inhibit knowledge uptake 95 ; exploring the role of shared decision making regarding more expensive or invasive test options when diagnostic uncertainty persists 96 ; and finally, designing implementation sciencebased approaches to accelerate a more efficacious and effective ED dizziness evaluation since traditional medical education and publications have not altered this paradigm.…”

Section: M Itati O N Smentioning

confidence: 99%

“…The next steps in research include standardized approach to patients with dizziness and vertigo into syndromes by timing and triggers including AVS and episodic vestibular syndrome; standardization of diagnostic criteria; quantifying reliability of the element of the history and the physical examination; training of providers in diagnostic maneuvers and treatment with canal repositioning when indicated; studies of reliability and reproducibility of training emergency physicians and other clinicians; assessing the method and duration of physician education to attain and maintain proficiency at HINTS, STANDING algorithm, VOG, etc 92–94 95 ; exploring the role of shared decision making regarding more expensive or invasive test options when diagnostic uncertainty persists 96 ; and finally, designing implementation science‐based approaches to accelerate a more efficacious and effective ED dizziness evaluation since traditional medical education and publications have not altered this paradigm.…”

Section: Limitationsmentioning

confidence: 99%

Diagnostic accuracy of the physical examination in emergency department patients with acute vertigo or dizziness: A systematic review and meta‐analysis for GRACE‐3

Shah

Silva

Farah

et al. 2023

Academic Emergency Medicine

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Background History and physical examination are key features to narrow the differential diagnosis of central versus peripheral causes in patients presenting with acute vertigo. We conducted a systematic review and meta‐analysis of the diagnostic test accuracy of physical examination findings. Methods This study involved a patient–intervention–control–outcome (PICO) question: (P) adult ED patients with vertigo/dizziness; (I) presence/absence of specific physical examination findings; and (O) central (ischemic stroke, hemorrhage, others) versus peripheral etiology. Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) was assessed. Results From 6309 titles, 460 articles were retrieved, and 43 met the inclusion criteria: general neurologic examination—five studies, 869 patients, pooled sensitivity 46.8% (95% confidence interval [CI] 32.3%–61.9%, moderate certainty) and specificity 92.8% (95% CI 75.7%–98.1%, low certainty); limb weakness/hemiparesis—four studies, 893 patients, sensitivity 11.4% (95% CI 5.1%–23.6%, high) and specificity 98.5% (95% CI 97.1%–99.2%, high); truncal/gait ataxia—10 studies, 1810 patients (increasing severity of truncal ataxia had an increasing sensitivity for central etiology, sensitivity 69.7% [43.3%–87.9%, low] and specificity 83.7% [95% CI 52.1%–96.0%, low]); dysmetria signs—four studies, 1135 patients, sensitivity 24.6% (95% CI 15.6%–36.5%, high) and specificity 97.8% (94.4%–99.2%, high); head impulse test (HIT)—17 studies, 1366 patients, sensitivity 76.8% (64.4%–85.8%, low) and specificity 89.1% (95% CI 75.8%–95.6%, moderate); spontaneous nystagmus—six studies, 621 patients, sensitivity 52.3% (29.8%–74.0%, moderate) and specificity 42.0% (95% CI 15.5%–74.1%, moderate); nystagmus type—16 studies, 1366 patients (bidirectional, vertical, direction changing, or pure torsional nystagmus are consistent with a central cause of vertigo, sensitivity 50.7% [95% CI 41.1%–60.2%, moderate] and specificity 98.5% [95% CI 91.7%–99.7%, moderate]); test of skew—15 studies, 1150 patients (skew deviation is abnormal and consistent with central etiology, sensitivity was 23.7% [95% CI 15%–35.4%, moderate] and specificity 97.6% [95% CI 96%–98.6%, moderate]); HINTS (head impulse, nystagmus, test of skew)—14 studies, 1781 patients, sensitivity 92.9% (95% CI 79.1%–97.9%, high) and specificity 83.4% (95% CI 69.6%–91.7%, moderate); and HINTS+ (HINTS with hearing component)—five studies, 342 patients, sensitivity 99.0% (95% CI 73.6%–100%, high) and specificity 84.8% (95% CI 70.1%–93.0%, high). Conclusions Most neurologic examination findings have low sensitivity and high specificity for a central cause in patients with acute vertigo or dizziness. In acute vestibular syndrome (monophasic, continuous, persistent dizziness), HINTS and HINTS+ have high sensitivity when performed by trained clinicians.

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“…Although these numbers were originally based on expert opinions, there are now several studies supporting them [11][12][13][14][15]. Once a high level of skill has been acquired, it seems to be retained, although it might need continued training and supervision to maintain it at the optimal level [16].…”

Section: Introductionmentioning

confidence: 99%

Self-reported skills and self-confidence in point-of-care ultrasound: a cross-sectional nationwide survey amongst Finnish emergency physicians

et al. 2023

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Background The use of point-of-care ultrasound (POCUS) is increasing. Numerous investigators have evaluated the learning curves in POCUS, but there are no published studies on how emergency physicians perceive their own competence level with this skill. Methods A nationwide survey amongst Finnish emergency physicians was conducted. The respondents reported their use of POCUS and how it has affected their clinical decision-making. The number of POCUS examinations performed was compared to the self-assessed skill level with different applications. Cut-off values were determined for the number of examinations required to acquire a good self-assessed skill level in each POCUS application. The correlation between self-confidence and the self-estimated skill level was analyzed. Several different statistical methods were used, such as Student’s t-test, Pearson’s correlation test, Loess method and ROC curve analysis. Results A total of 134 out of 253 Finnish emergency medicine specialists and residents (52%) responded to the survey. The most commonly used POCUS applications were POCUS-assisted procedures, pleural effusion and pneumothorax, inferior vena cava and lower extremity deep venous thrombosis. The initial rate of perceived skill acquisition was very steep with the curve flattening with greater skill and more experience. The number of examinations performed to reach a self-assessed good competence varied from seven to 75 with different applications. The lowest cut-off point for self-assessed good competence was obtained for rapid ultrasound for the shock and hypotension-protocol and the highest for focused cardiac examinations. There was an excellent correlation between self-confidence and the self-assessed skill level. Conclusions The Finnish emergency practitioners’ self-assessed development of POCUS skills parallels the previously published learning curves of POCUS. The correlation of self-confidence and the self-assessed skill level was found to be excellent. These findings add information on the development of perceived POCUS skills amongst emergency physicians and could complement a formal performance assessment.

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Longitudinal accuracy analysis of ultrasound performed during a four‐year emergency medicine residency

Cited by 5 publications

References 15 publications

Impact of Different Training Methods on Daily Use of Point-of-Care Ultrasound

Impact of Different Training Methods on Daily Use of Point-of-Care Ultrasound

Diagnostic accuracy of the physical examination in emergency department patients with acute vertigo or dizziness: A systematic review and meta‐analysis for GRACE‐3

Self-reported skills and self-confidence in point-of-care ultrasound: a cross-sectional nationwide survey amongst Finnish emergency physicians

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