Evaluation of short training session for venous limited compression ultrasonography: prospective multicenter study.
Emergency
Ultrasound
Ultrasound in medical education
Vascular ultrasound
Journal
The ultrasound journal
ISSN: 2524-8987
Titre abrégé: Ultrasound J
Pays: Italy
ID NLM: 101742146
Informations de publication
Date de publication:
03 Feb 2020
03 Feb 2020
Historique:
received:
12
09
2019
accepted:
24
01
2020
entrez:
5
2
2020
pubmed:
6
2
2020
medline:
6
2
2020
Statut:
epublish
Résumé
Venous limited compression ultrasonography (VLCU) is recommended in case of suspicion of deep venous thrombosis (DVT). Current training pathways are rather long and include experiential phase. This aim of this study was to investigate the efficacy of a short training session for VLCU without experiential phase. The training session was applied in residents without previous ultrasound skills. Program included operation of ultrasound device and interpretation of venous images. Included patients were older than 18 years and had a suspicion of DVT. After realization of VLCU using usual technique, residents reported the dynamic compressibility of the femoral and popliteal veins, the presence or not of a visible thrombus, self-reported difficulty and duration. Patients then underwent a whole leg ultrasonography (WLCU) in the local laboratory which was blinded to VLCU results. The main criterion was the negative-predictive value (NPV) of VLCU for the absence of proximal DVT diagnosed with WLCU. Secondary criteria were VLCU diagnostic performances, rate of inability to conclude, difficulty and duration. For a NPV of 95 ± 6%, the needed number of patients was 96. This study was approved by the ethical committee. 102 patients were analyzed. 46 residents were trained. A DVT was diagnosed by WLCU in 18 patients (prevalence of 17.6% [95% CI 11-26%]). VLCU detected 15 DVT (NPV of 96% [95% CI 89-99%]). The positive likelihood ratio was 9.9, the negative likelihood ratio 0.19 and Cohen's Kappa 0.62 [95% CI 0.52-0.71]. The sensitivity was 83% [CI 95% 60-94%] and specificity 88% [CI 95% 79-93%]. The mean number of VLCU by residents was 2.3 ± 2.1, median 2 (minimum 1, maximum 8). Mean duration was 3.4 min, difficulty was 3.7 ± 2. The principal objective, NPV 96% [95% CI 89-99%], was achieved. However, this short training session was inadequate to allow ruling-out a DVT with sufficient security. Thus, the experiential phase seems to be essential.
Sections du résumé
BACKGROUND
BACKGROUND
Venous limited compression ultrasonography (VLCU) is recommended in case of suspicion of deep venous thrombosis (DVT). Current training pathways are rather long and include experiential phase. This aim of this study was to investigate the efficacy of a short training session for VLCU without experiential phase. The training session was applied in residents without previous ultrasound skills. Program included operation of ultrasound device and interpretation of venous images. Included patients were older than 18 years and had a suspicion of DVT. After realization of VLCU using usual technique, residents reported the dynamic compressibility of the femoral and popliteal veins, the presence or not of a visible thrombus, self-reported difficulty and duration. Patients then underwent a whole leg ultrasonography (WLCU) in the local laboratory which was blinded to VLCU results. The main criterion was the negative-predictive value (NPV) of VLCU for the absence of proximal DVT diagnosed with WLCU. Secondary criteria were VLCU diagnostic performances, rate of inability to conclude, difficulty and duration. For a NPV of 95 ± 6%, the needed number of patients was 96. This study was approved by the ethical committee.
RESULTS
RESULTS
102 patients were analyzed. 46 residents were trained. A DVT was diagnosed by WLCU in 18 patients (prevalence of 17.6% [95% CI 11-26%]). VLCU detected 15 DVT (NPV of 96% [95% CI 89-99%]). The positive likelihood ratio was 9.9, the negative likelihood ratio 0.19 and Cohen's Kappa 0.62 [95% CI 0.52-0.71]. The sensitivity was 83% [CI 95% 60-94%] and specificity 88% [CI 95% 79-93%]. The mean number of VLCU by residents was 2.3 ± 2.1, median 2 (minimum 1, maximum 8). Mean duration was 3.4 min, difficulty was 3.7 ± 2.
CONCLUSION
CONCLUSIONS
The principal objective, NPV 96% [95% CI 89-99%], was achieved. However, this short training session was inadequate to allow ruling-out a DVT with sufficient security. Thus, the experiential phase seems to be essential.
Identifiants
pubmed: 32016592
doi: 10.1186/s13089-020-0155-2
pii: 10.1186/s13089-020-0155-2
pmc: PMC6997306
doi:
Types de publication
Journal Article
Langues
eng
Pagination
5Références
JAMA. 2008 Oct 8;300(14):1653-9
pubmed: 18840838
Blood Adv. 2018 Nov 27;2(22):3226-3256
pubmed: 30482764
Acad Emerg Med. 2007 Mar;14(3):216-20
pubmed: 17264203
Acad Emerg Med. 2015 May;22(5):574-82
pubmed: 25903780
Am J Emerg Med. 2012 Nov;30(9):1943-9
pubmed: 22795427
Lancet Haematol. 2016 Dec;3(12):e556-e562
pubmed: 27836513
Medicine (Baltimore). 2019 May;98(22):e15791
pubmed: 31145304
J Emerg Med. 2007 Feb;32(2):197-200
pubmed: 17307633
Acad Emerg Med. 2004 Mar;11(3):319-22
pubmed: 15001419
Ann Emerg Med. 2010 Dec;56(6):601-10
pubmed: 20864215
Thromb Haemost. 2013 Jan;109(1):137-45
pubmed: 23138420
Ann Emerg Med. 2017 May;69(5):e27-e54
pubmed: 28442101
Ann Emerg Med. 2008 Oct;52(4):437-45
pubmed: 18562044
Acad Emerg Med. 2010 Sep;17(9):1024-7
pubmed: 20836789
Acad Emerg Med. 2000 Feb;7(2):120-6
pubmed: 10691069
Lancet. 1997 Dec 20-27;350(9094):1795-8
pubmed: 9428249