Bieler Sandra, von Düring Stephan, Tagan Damien, Grosgurin Olivier, Fumeaux Thierry
Médecin cheffe, Service des Urgences, Hôpital de Sion, Sion, 1950, Switzerland.
Faculté de Médecine de l'Université de Genève, Hôpitaux Universitaires de Genève, Genève, Switzerland.
JMIRx Med. 2025 Mar 3;6:e53276. doi: 10.2196/53276.
Due to its diagnostic accuracy, point-of-care ultrasound (POCUS) is becoming more frequently used in the emergency department (ED), but the feasibility of its use by in-training residents and the potential clinical impact have not been assessed.
This study aimed to assess the feasibility of implementing a structured POCUS training program for in-training ED residents, as well as the clinical impact of their use of POCUS in the management of patients in the ED.
IMPULSE (Impact of a Point-of Care Ultrasound Examination) is a before-and-after implementation study evaluating the impact of a structured POCUS training program for ED residents on the management of patients admitted with acute respiratory failure (ARF) and/or circulatory failure (ACF) in a Swiss regional hospital. The training curriculum was organized into 3 steps and consisted of a web-based training course; an 8-hour, practical, hands-on session; and 10 supervised POCUS examinations. ED residents who successfully completed the curriculum participated in the postimplementation phase of the study. Outcomes were time to ED diagnosis, rate and time to correct diagnosis in the ED, time to prescribe appropriate treatment, and in-hospital mortality. Standard statistical analyses were performed using chi-square and Mann-Whitney U tests as appropriate, supplemented by Bayesian analysis, with a Bayes factor (BF)>3 considered significant.
A total of 69 and 54 patients were included before and after implementation of the training program, respectively. The median time to ED diagnosis was 25 (IQR 15-60) minutes after implementation versus 30 (IQR 10-66) minutes before implementation, a difference that was significant in the Bayesian analysis (BF=9.6). The rate of correct diagnosis was higher after implementation (51/54, 94% vs 36/69, 52%; P<.001), with a significantly shorter time to correct diagnosis after implementation (25, IQR 15-60 min vs 43, IQR 11-70 min; BF=5.0). The median time to prescribe the appropriate therapy was shorter after implementation (47, IQR 25-101 min vs 70, IQR 20-120 min; BF=2.0). Finally, there was a significant difference in hospital mortality (9/69, 13% vs 3/54, 6%; BF=15.7).
The IMPULSE study shows that the implementation of a short, structured POCUS training program for ED residents is not only feasible but also has a significant impact on their initial evaluation of patients with ARF and/or ACF, improving diagnostic accuracy, time to correct diagnosis, and rate of prescribing the appropriate therapy and possibly decreasing hospital mortality. These results should be replicated in other settings to provide further evidence that implementation of a short, structured POCUS training curriculum could significantly impact ED management of patients with ARF and/or ACF.
由于其诊断准确性，床旁超声（POCUS）在急诊科（ED）的使用越来越频繁，但尚未评估住院医师培训期间使用该技术的可行性及其潜在的临床影响。
本研究旨在评估为急诊住院医师实施结构化POCUS培训计划的可行性，以及他们在急诊科患者管理中使用POCUS的临床影响。
IMPULSE（床旁超声检查的影响）是一项前后实施研究，评估针对瑞士一家地区医院急诊科住院医师的结构化POCUS培训计划对急性呼吸衰竭（ARF）和/或循环衰竭（ACF）患者管理的影响。培训课程分为3个步骤，包括在线培训课程、8小时的实践操作课程以及10次监督下的POCUS检查。成功完成课程的急诊住院医师参与了研究的实施后阶段。结果指标包括急诊科诊断时间、急诊科正确诊断率和时间、开出适当治疗的时间以及住院死亡率。使用卡方检验和Mann-Whitney U检验进行标准统计分析，并辅以贝叶斯分析，贝叶斯因子（BF）>3被认为具有统计学意义。
培训计划实施前后分别纳入了69例和54例患者。实施后急诊科诊断的中位时间为25（四分位间距15 - 60）分钟，而实施前为30（四分位间距10 - 66）分钟，贝叶斯分析显示差异具有统计学意义（BF = 9.6）。实施后正确诊断率更高（51/54，94%对36/69，52%；P <.001），实施后正确诊断的时间显著缩短（25，四分位间距15 - 60分钟对43，四分位间距11 - 70分钟；BF = 5.0）。实施后开出适当治疗的中位时间更短（47，四分位间距25 - 101分钟对70，四分位间距20 - 120分钟；BF = 2.0）。最后，住院死亡率存在显著差异（9/69，13%对3/54，6%；BF = 15.7）。
IMPULSE研究表明，为急诊住院医师实施简短的结构化POCUS培训计划不仅可行，而且对他们对ARF和/或ACF患者的初始评估有显著影响，提高了诊断准确性、正确诊断时间、开出适当治疗的比例，并可能降低住院死亡率。这些结果应在其他环境中重复验证，以提供进一步证据证明实施简短的结构化POCUS培训课程可显著影响急诊科对ARF和/或ACF患者的管理。
