Number of attempts required by emergency physicians to achieve competency in diaphragmatic ultrasound imaging

Abstract

Purpose: This research aimed to determine the number of attempts that emergency physicians need to become proficient in undertaking diaphragmatic ultrasound imaging.Methods: A prospective observational study was conducted at the emergency department (ED) of a tertiary-care university hospital. Sixteen emergency physicians were each required to obtain a set of images of the right hemidiaphragm of five dyspneic patients using both diaphragmatic excursion and thickness techniques. The images were subsequently reviewed by a specialist using American College of Emergency Physician guidelines. If the evaluations of a physician did not reach the expected standard, the physician was to be given feedback and requested to collect images from another five patients. The process was to be repeated until such time as the images obtained by the physician were deemed to be up to standard.Results: Eighty patients, twelve emergency medicine residents, and four attending physicians were enrolled. Following a didactic session on diaphragmatic ultrasound imaging and its interpretation, practicing on five patients proved sufficient to achieve an adequate level of competency in conducting diaphragmatic ultrasound examinations. Conclusion:Practicing on five patients is sufficient for emergency physicians to achieve an adequate level of competency in conducting right-sided diaphragmatic ultrasound examinations.

The Incidence of Diaphragmatic Dysfunction in Patients Presenting With Dyspnea in the Emergency Department

“…However, recent studies have revealed that DD can occur not only in chronic settings but also in acute settings, such as sepsis, congestive heart failure, and respiratory tract infections. 22 Unfortunately, studies on diaphragmatic function in acute settings, particularly in the ED, are limited.…”

“…This finding concords with a previous study on acute dyspneic patients in the ED. 18,22 One explanation for this negative finding is the hypothesis that the dysfunction of multiple organ systems influences dyspnea. Thus, DD alone cannot account for patients' need for respiratory support or mortality.…”

“…Drawing upon a previous study, 22 we assumed that the incidence of DD in patients visiting the ED with dyspnea would be 20%. Based on a 95% confidence interval (CI) of 20 ± 5%, 246 patients were needed.…”

“…[18][19][20][21] 21 A recent study conducted in an ED found that diaphragmatic ultrasound was feasible and trainable for emergency physicians. 22 To our knowledge, no studies have demonstrated the incidence of DD in acute settings such as the ED. Thus, this study aimed to determine the incidence of DD in patients presenting with dyspnea in the ED.…”

“…Most published studies relating to EDs have focused on patients with an acute exacerbation of COPD and the relationship between DD and noninvasive ventilation failure 18–21 . A recent study conducted in an ED found that diaphragmatic ultrasound was feasible and trainable for emergency physicians 22 …”