Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: a LUST trial sub-project

Abstract

Within the framework of the LUST trial (LUng water by Ultra-Sound guided Treatment to prevent death and cardiovascular events in high-risk end-stage renal disease patients), the European Renal and Cardiovascular Medicine (EURECA-m) working group of the European Renal Association-European Dialysis Transplant Association established a central core lab aimed at training and certifying nephrologists and cardiologists participating in this trial. All participants were trained by an expert trainer with an entirely web-based programme. Thirty nephrologists and 14 cardiologists successfully completed the training. At the end of training, a set of 47 lung ultrasound (US) videos was provided to trainees who were asked to estimate the number of B-lines in each video. The intraclass correlation coefficient (ICC) for the whole series of 47 videos between each trainee and the expert trainer was high (average 0.81 ± 0.21) and >0.70 in all but five cases. After further training, the five underperforming trainees achieved satisfactory agreement with the expert trainer (average post-retraining ICC 0.74 ± 0.14). The Bland-Altman plot showed virtually no bias (difference between the mean 0.03) and strict 95% limits of agreement lines (-1.52 and 1.45 US B-lines). Only four cases overlapped but did not exceed the same limits. Likewise, the Spearman correlation coefficient applied to the same data series was very high (r = 0.979, P < 0.0001). Nephrologists and cardiologists can be effectively trained to measure lung congestion by an entirely web-based programme. This web-based training programme ensures high-quality standardization of US B-line measurements and represents a simple, costless and effective preparatory step for clinical trials targeting lung congestion.

Lung ultrasound training: a systematic review of published literature in clinical lung ultrasound training

“…Supervised scans with immediately feedback with focus on image acquisition, afterwards image interpretation by blinded observer22 respiratory therapists Greenstein et al [24]Pre- and post-testTheoretical pre- and post-test (20 MCQs) and hands-on assessmentHealthy human models3 days course including didactic lectures with real-time ultrasound scan on healthy models, image interpretation sessions and hands-on training363 critical care physicians, hospitalists, surgeons, physician assistants, advanced practice nurses and medical residentsDescriptive studies Krishnan et al [25]Post course evaluation and sustainability testTheoretical post- and sustainability test (20 video clips ± pneumothorax)Ultrasound video of 53 patients before and after elective thoracic surgery. In all, 99 videos were compiled (52 without pneumothoraces and 47 with)5-min online presentation of the use of ultrasound for detection of pneumothorax79 (70 at 6 month follow-up) residents and faculty members from Department of anaesthesiaAbbasi et al [26]Prospective cross-sectional studyHands-on assessment (± pneumothorax)Healthy live models and patients admitted in Emergency Department with thoracic trauma2 h training course including 30 min didactic lecture, 30 min hands-on training on healthy volunteers, 1 h training on patientsFour emergency physiciansGargani et al [27]Post course evaluationOnline assessment of uploaded LUS examinations and theoretical assessment of b -line interpretation (44 videos)PatientsPart A: web-based training program; 26 min educational video with focus on b -line assessment. Upload of 7 self-performed lung ultrasound videos, when videos were approved by experts, trainees proceed to Part B: b -line interpretationThirty nephrologists and 14 cardiologistsRandomized controlled trial Edrich et al [28]Randomized controlled trial with 4 weeks follow-upTheoretical pre-, post-, and sustainability test (10 MCQs and one video clip) and practical examination (blinded reviewers)Healthy live modelsGroup I: web-based (powerpoint 25 min and online demonstration 5 min).…”

“…Accuracy of emergency physician-performed ultrasound in detecting traumatic pneumothorax after 2-h training course. 2012Sensitivity and specificity, positive after 5, 10 and 20 ultrasound examinations, × 2-test for proportions and the Student t test for continuous variablesImprovement in sensitivity/specificity after 5, 10 and 20 examinationsBy a brief learning course, the emergency physicians easily diagnosed PTX in trauma patients with a reasonable accuracy in comparison with CT scan as the gold standard4Gargani et al [27]. Efficacy of a remote web-based lung ultrasound training for nephrologists and cardiologists: an LUST trial sub-project.…”

“…Five of the pre- and post-test studies had a follow-up time from 1 week to 6 months, average 13 weeks ± 4.83 [14, 16, 18, 20, 25], and one recorded number of scans performed from baseline to follow-up [20]. Three descriptive studies were identified [25–27] and one randomized controlled trial [28]. Five of the studies (31%) were courses in general critical care ultrasound, or basic skill ultrasound, where thoracic or lung ultrasound was a specific and independently evaluated topic [17, 19–21, 24].…”

“…Web-based learning or online presentations were used in 7 (44%) studies [16, 19, 21, 23, 25, 27, 28]. Four of those had only online presentations or web-based learning modules without didactic lectures or hands-on sessions [16, 25, 27, 28].…”

“…Four of those had only online presentations or web-based learning modules without didactic lectures or hands-on sessions [16, 25, 27, 28]. Cuca et al studied a web-based learning program evaluated by nine experts of the international lung ultrasound consensus committee [16], and used the same written tests, topics, and curriculum as the study by Breitkreutz et al [15].…”