Evaluation of Emergency and Critical Care Medicine residents’ diagnostic accuracy in lung ultrasound interpretation in Addis Ababa, Ethiopia: a cross-sectional study at two public teaching hospitals

Abstract

Background: Point of Care ultrasound is defined as a goal-directed ultrasound exam performed by the treating physician to answer a well-defined question relevant to the immediate care of a patient. Currently, lung ultrasound is increasingly used in critically ill patients as an alternative to bedside chest radiography. Point of care ultrasound is a mandatory training for emergency and critical care physicians but there are no published papers on the diagnostic accuracy of lung ultrasound performed by emergency medicine residents. This study aims to assess the diagnostic accuracy of emergency medicine residents’ chest ultrasound interpretation at two public hospitals in Addis Ababa, Ethiopia. Methods: A cross-sectional study targeting senior emergency residents in two hospitals in comparison with radiologists. The study was conducted from June 2022 to August 2022 by using a structured questionnaire. There were a total of 70 emergency residents at these hospitals. The completed data was coded, manually checked, and exported to SPSS version 25 for data analysis. Results:60 emergency and critical care medicine residents were enrolled in this study among which 28 (46.7%) were from Addis Ababa University and 32 (53.3%) were from St. Paul’s Hospital Millennium Medical College. The overall accuracy in the interpretation of chest ultrasound was low. The sensitivity of residents in detecting normal chest ultrasounds was 95%. Most residents correctly identified pneumothorax at 96.7% and the lowest rate of interpretation was lung metastasis at 5%. There is a moderate agreement between emergency residents and radiologists (kappa 0.4). There is no factor identified that has a significant association with the outcome of interpreting chest ultrasound scans. Conclusion: The skills of residents in interpreting chest ultrasound results are low regardless of the prevalence of the condition in the emergency room or the relative clinical importance of the condition. Poor sensitivity results with misinterpretations were common. Recommendation: we recommend the need for continuous training and assessment of the residents on lung ultrasound scanning. Further studies should be done, to fill the gaps and improve the quality of teaching.