Prospective assessment of a score for assessing basic critical-care transthoracic echocardiography skills in ventilated critically ill patients

Abstract

Background: We studied a score for assessing basic transthoracic echocardiography (TTE) skills exhibited by residents who examined critically ill patients receiving mechanical ventilation.

Methods: We conducted a prospective study in the 16 residents who worked in our medical-surgical ICU between 1 May 2008 and 1 November 2009. The residents received theoretical teaching (two hours) then performed supervised TTEs during their six-month rotation. Their basic TTE skills in mechanically ventilated patients were evaluated after one (M1), three (M3), and six (M6) months by two experts, who used a scoring system devised for the study. After scoring, residents gave their hemodynamic diagnosis and suggested a treatment.

Results: The 4 residents with previous TTE skills obtained a significantly higher total score than did the 12 novices at M1 (18 (16 to 19) versus 13 (10 to 15), respectively, P = 0.03). In the novices, the total score increased significantly during training (M1, 13 (10 to 14); M3, 15 (12 to 16); and M6, 17 (15 to 18); P < 0.001) and correlated significantly with the number of supervised TTEs (r = 0.68, P < 0.0001). In the overall population, agreement with experts regarding the diagnosis and treatment was associated with a significantly higher total score (17 (16 to 18) versus 13 (12 to 16), P = 0.002). A total score ≥ 19/20 points had 100% specificity (95% confidence interval, 79 to 100%) for full agreement with the experts regarding the diagnosis and treatment.

Conclusions: Our results validate the scoring system developed for our study of the assessment of basic critical-care TTE skills in residents.

Keywords: Basic critical-care echocardiography skills; Goal-oriented bedside echocardiography; Hemodynamic assessment; Intensive care unit; Non-cardiologist intensivists.

Figure 1

Total transthoracic echocardiography scores at M1 in the 12 novices and 4 skilled residents. The box shows the 25th and 75th percentiles, the line in the box the median, and the whiskers the 5th and 95th percentiles.

Figure 2

Total transthoracic echocardiography scores at M1, M3, and M6 in the 12 novices. The box shows the 25th and 75th percentiles, the line in the box the median, and the whiskers the 5th and 95th percentiles.

Figure 3

Correlation between the total transthoracic echocardiography (TTE) score and the number of supervised TTEs performed by the novices at M1, M3, and M6. N = 33. The line is the correlation line; total scores at M1 are shown as squares, at M3 as circles, and at M6 as triangles.

Figure 4

Total transthoracic echocardiography score according to agreement for both the diagnosis and the treatment between residents (N = 16) and experts. The box shows the 25th and 75th percentiles, the line in the box the median, and the whiskers the 5th and 95th percentiles.