Methodologic Quality of Guidelines for Training or Competence Processes for Basic Point-of-Care Echocardiography in Critical Care

Abstract

BACKGROUND:The formulation of expert opinion guidelines has several sources of bias that may adversely affect their quality. To minimize bias, guideline creators must use rigorous methodology. There has been no appraisal of the methodologic quality of basic critical care echocardiography (BCCE) training/education guidelines. RESEARCH QUESTION: What is the methodologic quality of expert guidelines/recommendations on BCCE training? STUDY DESIGN AND METHODS:The review was performed by a multidisciplinary team including intensive care specialists, a hospital scientist, a trainee, a nurse sonographer, and a public health expert. Four databases (PubMed, OVID-Embase, Clarivate Analytics Web of Science, and Google Scholar) were searched on July 31, 2020, to identify guidelines on BCCE training/education. Every guideline was assessed subjectively for the degree of detail of the recommendations and assessed objectively by using the AGREE-II critical appraisal tool for clinical practice guidelines to generate a scaled domain score. A score $ 75% in every domain was the cut off for guidelines to be used without modifications. RESULTS: From 4,288 abstracts screened, 24 guidelines met the inclusion criteria. Very few guidelines made clear recommendations regarding introductory courses: physics (n ¼ 6 [25%]), instrumentation (n ¼ 5 [20.8%]), image acquisition theory (n ¼ 6 [25%]), course curriculum (n ¼ 5 [[20.8%]), pre-course/post-course tests (n ¼ 1 [4.2%]), minimum course duration (n ¼ 6 [25%]), or trainer qualifications (n ¼ 5 [20.8%]). Very few provided clear recommendations for longitudinal competence programs: clinically indicated scans (n ¼ 8 [33.3%]), logbook (n ¼ 14 [58.3%]), image storage (n ¼ 9 [37.5%]), formative assessment (n ¼ 6 [25%]), minimum scan numbers (n ¼ 14 [58.3%]), image acquisition competence (n ¼ 3 [12.5%]), image interpretation competence (n ¼ 2 [8.3%]), and credentialing/certification (n ¼ 3 [12.5%]). Five guidelines (20.8%) attained a scaled overall AGREE-II score $ 75%. One guideline (4.2%) attained scores $ 75% in every domain. INTERPRETATION:The methodologic appraisal of BCCE-training guidelines showed widespread deficiencies in guideline formulation processes. The impact of these deficiencies on the validity of the recommendations requires further evaluation in longitudinal studies.

Guidelines for Ultrasound Training in Critical Care

“…Many barriers had been described, such as the lack of trainers or agreed competences. 5,9 Moreover, the optimal method of training has yet to be defined and supported with highquality evidence, as previously described by Rajamani et al 6 The review by Rajamani et al 7 shows the lack of highquality guidelines; however, it is still not demonstrated that application of systematic methods during guideline development will result in outcome improvement in training and competence on BCCE. The highest quality guideline still requires being applicable in the field.…”

“…In this issue of CHEST, Rajamani et al 7 wanted to assess the methodologic quality of guidelines for basic point of care ECG training in critical care (BCCE). They conducted a systematic review of expert recommendations or guidelines on BCCE training that had been published in English in a peer-reviewed journal or societal website.…”

“…This systematic review presents a novel approach to evaluate guidelines: the quality approach. 7 Strengths of this review are well-designed methods that included explicit inclusion and exclusion criteria and clear detail on data extraction and processing. On the other hand, they used the AGREE-II appraisal tool on their objective evaluation, which was not designed specifically for ultrasound imaging guidelines, but for clinical practice guidelines.…”

Criteria, Processes, and Determination of Competence in Basic Critical Care Echocardiography Training

“…[1][2][3] Because there are very few high-quality studies on longitudinal BCCE training, 1 expert opinion recommendations are important in guiding BCCE competence educational standards and processes. 4 Broad conceptual frameworks on BCCE competence have been issued by several expert panels, including the American College of Emergency Physicians, the American College of Chest Physicians/La Société de Réanimation de Langue Française, an Expert Round Table on Ultrasound, and, more recently, by the European Society of Intensive Care Medicine. 3,[5][6][7][8][9] However, Wong et al 10 highlighted significant variability in competence criteria and policies in BCCE programs across various countries.…”

“…A recent systematic review that appraised BCCE training guidelines showed a widespread lack of adherence to systematic methods during the guideline formulation process. 4,11 Most guidelines issued their recommendations using aspirational/subjective terms rather than detailing precise criteria on the process of training. The authors recommended that any future expert panel guidelines must adhere to a systematic process of guideline formulation that includes the domains in a validated tool, such as the AGREE-II Critical Appraisal Tool for Clinical Practice Guidelines (Advancing Guideline Development, Reporting and Evaluation in health care).…”