From the Division of Emergency Medicine, Department of Pediatrics, Children's Hospital at London Health Sciences Centre, London, Ontario.
Department of Emergency Medicine, IWK Health and Dalhousie University, Halifax, Nova Scotia, Canada.
Pediatr Emerg Care. 2022 Feb 1;38(2):e849-e855. doi: 10.1097/PEC.0000000000002396.
Using an education and assessment tool, we examined the number of cases necessary to achieve a performance benchmark in image interpretation of pediatric soft tissue, cardiac, lung, and focused assessment with sonography for trauma (FAST) point-of-care ultrasound (POCUS) applications. We also determined interpretation difficulty scores to derive which cases provided the greatest diagnostic challenges.
Pediatric emergency physicians participated in web-based pediatric POCUS courses sponsored by their institution as a credentialing priority. Participants deliberately practiced cases until they achieved diagnostic interpretation scores of combined 90% accuracy, sensitivity, and specificity.
Of the 463 who enrolled, 379 (81.9%) completed cases. The median (interquartile range) number of cases required to achieve the performance benchmark for soft tissue was 94 (68-128); cardiac, 128 (86-201); lung, 87 (25-118); and FAST, 93 (68-133) (P < 0001). Specifically, cases completed to achieve benchmark were higher for cardiac relative to other applications (P < 0.0001 for all comparisons). In soft tissue cases, a foreign body was more difficult to diagnose than cobblestoning and hypoechoic collections (P = 0.036). Poor cardiac function and abnormal ventricles were more difficult to interpret with accuracy than normal (P < 0.0001) or pericardial effusion cases (P = 0.01). The absence of lung sliding was significantly more difficult to interpret than normal lung cases (P = 0.028). The interpretation difficulty of various FAST imaging findings was not significantly different.
There was a significant variation in number of cases required to reach a performance benchmark. We also identified the specific applications and imaging findings that demonstrated the greatest diagnostic challenges. These data may inform future credentialing guidelines and POCUS learning interventions.
使用教育和评估工具，我们检查了在儿科软组织、心脏、肺部和创伤重点评估的超声检查（FAST）即时超声检查（POCUS）应用中进行图像解释所需的病例数，以达到性能基准。我们还确定了解释困难评分，以确定哪些病例具有最大的诊断挑战。
儿科急诊医师参加由其机构主办的基于网络的儿科 POCUS 课程，作为认证优先事项。参与者故意练习病例，直到他们达到综合诊断解释评分 90%的准确率、敏感度和特异性。
在注册的 463 人中，379 人（81.9%）完成了病例。达到软组织性能基准所需的病例中位数（四分位间距）为 94（68-128）；心脏，128（86-201）；肺部，87（25-118）；FAST，93（68-133）（P<0.0001）。具体来说，相对于其他应用程序，心脏完成的病例达到基准更高（所有比较均为 P<0.0001）。在软组织病例中，与鹅卵石样改变和低回声性积液相比，异物更难诊断（P=0.036）。与正常（P<0.0001）或心包积液病例相比，心功能差和心室异常的准确性更难解释（P<0.0001）。缺乏肺滑动比正常肺病例更难解释（P=0.028）。各种 FAST 成像发现的解释难度没有显著差异。
达到性能基准所需的病例数量存在显著差异。我们还确定了表现出最大诊断挑战的特定应用程序和成像发现。这些数据可能为未来的认证指南和 POCUS 学习干预措施提供信息。
