Pediatric Intensive Care Unit, Hospital Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
Immunological and Respiratory Disorders in the Pediatric Critical Patient Research Group, Institut de Recerca Sant Joan de Déu, University of Barcelona, Barcelona, Spain.
Pediatr Res. 2022 Oct;92(4):1115-1121. doi: 10.1038/s41390-021-01928-2. Epub 2021 Dec 30.
Lung ultrasound (LUS) for critical patients requires trained operators to perform them, though little information exists on the level of training required for independent practice. The aims were to implement a training plan for diagnosing pneumonia using LUS and to analyze the inter-observer agreement between senior radiologists (SRs) and pediatric intensive care physicians (PICPs).
Prospective longitudinal and interventional study conducted in the Pediatric Intensive Care Unit of a tertiary hospital. Following a theoretical and practical training plan regarding diagnosing pneumonia using LUS, the concordance between SRs and the PICPs on their LUS reports was analyzed.
Nine PICPs were trained and tested on both theoretical and practical LUS knowledge. The mean exam mark was 13.5/15. To evaluate inter-observer agreement, a total of 483 LUS were performed. For interstitial syndrome, the global Kappa coefficient (K) was 0.51 (95% CI 0.43-0.58). Regarding the presence of consolidation, K was 0.67 (95% CI 0.53-0.78), and for the consolidation pattern, K was 0.82 (95% CI 0.79-0.85), showing almost perfect agreement.
Our training plan allowed PICPs to independently perform LUS and might improve pneumonia diagnosis. We found a high inter-observer agreement between PICPs and SRs in detecting the presence and type of consolidation on LUS.
Lung ultrasound (LUS) has been proposed as an alternative to diagnose pneumonia in children. However, the adoption of LUS in clinical practice has been slow, and it is not yet included in general clinical guidelines. The results of this study show that the implementation of a LUS training program may improve pneumonia diagnosis in critically ill patients. The training program's design, implementation, and evaluation are described. The high inter-observer agreement between LUS reports from the physicians trained and expert radiologists encourage the use of LUS not only for pneumonia diagnosis, but also for discerning bacterial and viral patterns.
对于危重症患者的肺部超声（LUS）检查需要经过专业培训的操作人员来进行，尽管关于独立实践所需的培训水平的信息很少。本研究旨在实施一项使用 LUS 诊断肺炎的培训计划，并分析高级放射科医师（SR）和儿科重症监护医师（PICPs）之间的观察者间一致性。
这是一项在一家三级医院的儿科重症监护病房进行的前瞻性纵向和干预性研究。在接受了关于使用 LUS 诊断肺炎的理论和实践培训计划后，分析了 SR 和 PICPs 在 LUS 报告中的一致性。
共培训了 9 名 PICPs，并对他们进行了理论和实践 LUS 知识的测试。平均考试成绩为 13.5/15。为了评估观察者间的一致性，总共进行了 483 次 LUS 检查。对于间质性综合征，总体 Kappa 系数（K）为 0.51（95%CI 0.43-0.58）。关于实变的存在，K 为 0.67（95%CI 0.53-0.78），而实变模式的 K 为 0.82（95%CI 0.79-0.85），显示出几乎完美的一致性。
我们的培训计划使 PICPs 能够独立进行 LUS 检查，并可能改善肺炎的诊断。我们发现 PICPs 和 SRs 在检测 LUS 上实变的存在和类型方面具有很高的观察者间一致性。
肺部超声（LUS）已被提议作为诊断儿童肺炎的替代方法。然而，LUS 在临床实践中的应用进展缓慢，尚未被纳入一般临床指南。本研究结果表明，实施 LUS 培训计划可能会改善危重症患者的肺炎诊断。描述了培训计划的设计、实施和评估。接受培训的医生和专家放射科医生之间的高观察者间一致性报告鼓励不仅将 LUS 用于肺炎诊断，还用于区分细菌和病毒模式。
