Cumulative sum (CUSUM) analysis in the assessment of trainee competence in fetal biometry measurement

Weerasinghe, S.; Mirghani, H.; Revel, Ariel; Abu‐Zidan, Fikri M.

doi:10.1002/uog.2828

Cited by 36 publications

(36 citation statements)

References 25 publications

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“…Weerasinghe et al studied three trainees who learned ultrasonic fetal biometry measurements. 11 Each trainee studied 100 patients. They found that 13 to 30 cases were required to measure fetal biparietal diameter at the 90% level of accuracy.…”

Section: Discussionmentioning

confidence: 99%

The use of ultrasound for lumbar spinous process identification: A pilot study

Halpern

Banerjee

Stocche

et al. 2010

Can J Anesth/J Can Anesth

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Background Clinical identification of lumbar spinous processes is inaccurate in most patients. The purpose of this study was to determine the number of patients required to train anesthesiologists in the use of ultrasound imaging to accurately identify the lumbar spinous processes. Methods In this pilot study, two anesthesiologists studied patients scheduled for a diagnostic computed tomography (CT) scan, including the lumbar spine. Before the CT scan, the anesthesiologist completed a systematic ultrasound scan of the lumbar spine and placed a radio-opaque marker at a designated level. The actual level was determined by a radiologist after reviewing the CT scans. The primary outcome was the number of procedures each anesthesiologist needed (by cumulative sum analysis) to be able to identify the designated spinous process 90% of the time. Secondary outcomes included the overall success rate, the magnitude of the failures (number of segments from the designated spinous process), and the incidence of spinal anomalies and their effect on reliability.Results We studied 74 patients. One anesthesiologist required 36 patients to meet reliability criteria, whereas the other required 22 patients. The overall accuracy rate was 68%. There were only two patients where the marker was placed more than one segment from the designated spinous process. The incidence of lumbar spine anomalies was 6.8% (n = 5), and 80% (n = 4) of these were associated with inaccurate marker placement. Conclusions It is possible to use ultrasound scanning to accurately identify the lumbar spinous processes in unselected patients. This result suggests that, with appropriate training, this tool can be used to enhance the accuracy of needle placement during neuraxial techniques.

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Section: Discussionmentioning

confidence: 99%

The use of ultrasound for lumbar spinous process identification: A pilot study

Halpern

Banerjee

Stocche

et al. 2010

Can J Anesth/J Can Anesth

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“…In clinical medicine the need for quality control arose [21,22] , but only in the early 1990s several medical studies used CUSUM analysis to monitor operators' performance and to describe learning curves [23,24] . Nowadays, CUSUM analysis is increasingly used for various clinical procedures [25][26][27][28] . Risk-adjusted CUSUM has the advantage to take into account variations in pre-procedure or pre-operative risks [29] , but these must be identifiable and clearly defined.…”

Section: Discussionmentioning

confidence: 99%

Quality Control for Intravascular Intrauterine Transfusion Using Cumulative Sum (CUSUM) Analysis for the Monitoring of Individual Performance

Lindenburg¹,

Wolterbeek

Oepkes³

et al. 2011

Fetal Diagn Ther

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Introduction: Intravascular intrauterine transfusion (IUT) is an effective and relatively safe method for the treatment of fetal anemia. Although implemented in centers all over the world in the 1980s, the length and strength of the learning curve for this procedure has never been studied. Cumulative sum (CUSUM) analysis has been increasingly used as a graphical and statistical tool for quality control and learning curve assessment in clinical medicine. We aimed to test the feasibility of CUSUM analysis for quality control in fetal therapy by using this method to monitor individual performance of IUT in the learning phase and over the long term. Methods: IUTs performed in the Dutch referral center for fetal therapy from 1987 to 2009 were retrospectively classified as successful or failed. Failed was defined as no net transfusion or the occurrence of life-threatening procedure-related complications. The CUSUM statistical method was used to estimate individual learning curves and to monitor long-term performance. Four operators who each performed at least 200 procedures were included. Results: Individual CUSUM graphs were easily assessed. Both operators pioneering IUT in the late 1980s had long learning phases. The 2 operators learning IUT in later years in an experienced team performed acceptably from the start and reached a level of competence after 34 and 49 procedures. Discussion: CUSUM analysis is a feasible method for quality control in fetal therapy. In an experienced setting, individual competence may be reached after 30 to 50 IUTs. Our data suggest that operators need at least 10 procedures per year to keep a level of competence.

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“…That means that for each failure, the line will go up by 0.78 and for each success it will go down by 0.22 declaring competence when the plot falls below the lower boundary of h1, i.e. dropping below 2 consecutive boundary lines [15]. …”

Section: Methodsmentioning

confidence: 99%

“…CUSUM analysis was obtained for each intrapulmonary artery Doppler parameter according to elsewhere-published standard methodology [12,13,14,15,16,23,24,25] and using Excel for Windows 2010 (Microsoft Corp., Redmond, Wash., USA) statistical software. In brief, the CUSUM values are plotted on the y-axis and the number of examinations on the x-axis.…”

Section: Methodsmentioning

confidence: 99%

“…Cumulative sum (CUSUM) analysis is a graphic method that has been used as a quality control in monitoring doctors' performance on a case-by-case basis, showing changes in competence over time [12,13,14,15], and to assess learning curves by trainees in different diagnosis methods and surgical procedures. Similarly, we and others have evaluated the learning curve of several fetal ultrasound measurements using this methodology [16,17,18].…”

Section: Introductionmentioning

confidence: 99%

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Learning Curve for Intrapulmonary Artery Doppler in Fetuses with Congenital Diaphragmatic Hernia

et al. 2015

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Objective: To assess the learning curve for intrapulmonary artery Doppler in fetuses with congenital diaphragmatic hernia (CDH). Methods: Three fetal medicine fellows with the theoretic knowledge, but without prior experience, in the evaluation of intrapulmonary artery Doppler in CDH fetuses were selected. Each trainee and 1 experienced explorer assessed the intrapulmonary artery in the contralateral lung to the side of the hernia for calculation of 2 Doppler parameters - pulsatility index (PI) and peak early diastolic reversed flow (PEDRF) - in a cohort of 90 consecutive CDH fetuses. The average difference between the 3 trainees and the expert was calculated. A difference below 15% was considered as accurate measurement. The average learning curve was delineated using the cumulative sum analysis (CUSUM). Results: Among the total 270 intrapulmonary artery Doppler measurements performed by the 3 trainees, the number of failed examinations was 14 (15.6%) and 16 (17.8%) for PI and PEDRF, respectively. The CUSUM plots demonstrate that the learning curve was achieved by 53 and 63 tests performed for calculations of the intrapulmonary artery PI and PEDRF, respectively. Conclusion: Competence in Doppler evaluation of the intrapulmonary artery in CDH fetuses is achieved only after intensive continuous training.

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Cumulative sum (CUSUM) analysis in the assessment of trainee competence in fetal biometry measurement

Abstract: Objective To determine the value of cumulative sum (CUSUM) analysis in assessing trainee proficiency in fetal biometry measurement. Methods

Cited by 36 publications

References 25 publications

The use of ultrasound for lumbar spinous process identification: A pilot study

The use of ultrasound for lumbar spinous process identification: A pilot study

Quality Control for Intravascular Intrauterine Transfusion Using Cumulative Sum (CUSUM) Analysis for the Monitoring of Individual Performance

Learning Curve for Intrapulmonary Artery Doppler in Fetuses with Congenital Diaphragmatic Hernia

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