多少才足够?衡量急诊医学受训者达到能力要求所需的 FAST 考试次数。

IF 2 Q2 EMERGENCY MEDICINE
Ahmad Bakhribah, Jordan Leumas, Gregg Helland, Joshua Guttman, Yara Arfaj, Rawan Alharbi, Abdullah Bakhsh
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引用次数: 0

摘要

背景:对于腹部钝挫伤患者,创伤超声聚焦评估(FAST)检查是用于诊断和风险分层的初始成像模式。在这类患者中,FAST 检查呈阳性表示腹腔内出血。对于血流动力学不稳定的患者,有必要进行快速手术干预。超声检查在很大程度上取决于操作者获取高质量图像进行解读的能力。如果不能获得足够的图像,就无法进行准确的解读,从而降低诊断的准确性。之前有研究评估了 FAST 检查是否可以仅靠经验来改进,但结果相互矛盾。这些研究都没有使用客观的方法来评估 FAST 检查的质量。我们的研究旨在客观地确定急诊医学(EM)住院医师为达到足够的独立扫描质量所需的 FAST 检查次数。对 59 名急诊科住院医师保存在 Qpath 存档系统中的所有 FAST 检查(无论检查是出于教学目的还是临床目的)进行审查,并使用任务特定检查表 (TSC) 分数进行评分。该评分是评估 FAST 扫描熟练程度和质量的客观方法。TSC 以是否成功完成 24 个特定解剖标志物(分为四个解剖区域)的成像为依据。AEMUS(高级电磁超声造影)教员通过Qpath电子版或在床旁向学员提供反馈。根据超声成像质量和能力(QUICK Score),如果前10次检查的TSC平均分达到或超过18分,则该住院医师被视为专家。但是,如果住院医师未能达到该分数,我们会跳过住院医师进行的第一次检查,然后计算第二次至第十一次检查的平均分数。如果住院医师没有达到预期结果,则跳过第一次和第二次考试,然后计算其余 10 次考试的平均分。如此反复,直到住院医师的 TSC 平均分达到 18 分或更高:结果:共对 663 名急诊科住院医师进行的 FAST 扫描进行了评分。独立扫描所需的 FAST 检查平均次数为 11.23(95% CI,10.6-11.85)。66.1%的注册住院医师在前 10 次 FAST 检查中取得了 18 分或更高的平均分,33.8%的住院医师需要进行 10 次以上的扫描。右上腹(RUQ)、左上腹(LUQ)、骨盆和剑突下视图的平均得分分别为5分(95% CI,4.88-5.1)、4.7分(95% CI,4.59-4.8)、5.1分(95% CI,4.96-5.24)和3.7分(95% CI,3.6-3.8):本研究表明,如果对每次 FAST 考试都给予建设性反馈,一年级急诊科住院医师在完成 10-12 次(平均 11.23 次)FAST 考试后,平均就能独立完成 FAST 考试。还需要进一步的研究来验证研究结果。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
How many is enough? Measuring the number of FAST exams needed by emergency medicine trainees to reach competence.

Background: For patients with blunt abdominal trauma, the Focused Assessment with Sonography in Trauma (FAST) exam is the initial imaging modality employed to diagnose and risk stratify. A positive FAST exam in this patient population denotes intraperitoneal hemorrhage. In a hemodynamically unstable patient, it necessitates rapid surgical intervention. Ultrasound is highly dependent on the operator's ability to obtain quality images for interpretation. Failure to obtain adequate images prevents accurate interpretation and reduce its diagnostic accuracy. Previous studies evaluating whether the FAST exam can be improved solely by experience had conflicting results. None of those studies used an objective method to evaluate the FAST exam's quality. Our study aimed to objectively determine the number of FAST exams required by an emergency medicine (EM) resident to reach sufficient quality for independent scanning.

Methods: 59 first-year EM residents from a single site were included in this study. All FAST exams that were saved in the Qpath archival system by the 59 EM residents, whether the exam was performed for educational or clinical purposes, were reviewed, and scored using a Task-Specific Checklist (TSC) score. This score is an objective way to assess the proficiency and quality of the FAST scan. The TSC was based on whether the imaging of 24 specific anatomic landmarks, split into four anatomic regions, was completed successfully or not. The AEMUS (Advanced EM Ultrasonography) faculty provided feedback to trainees wither electronically via Qpath or at the bedside. According to the quality of ultrasound imaging and competence (QUICK Score), if the average TSC score for the first 10 exams was 18 or higher, the resident was considered an expert. However, if the resident failed to achieve that score, we skipped the first exam performed by the resident and the average score for the second through eleventh exams was then calculated. If the resident did not achieve the desired result, the first and second exams were skipped and the average score for the remaining 10 exams was determined. This sequence was repeated until the resident achieved an average score of 18 or higher on their TSC score.

Results: In total, 663 FAST scans performed by EM residents were scored. The average number of FAST exams needed for independent scanning is 11.23 (95% CI, 10.6-11.85). 66.1% of enrolled residents achieved an average score of 18 or higher in their first 10 FAST exams, and 33.8% of residents required more than 10 scans. The average scores for the right upper quadrant (RUQ), left upper quadrant (LUQ), pelvic, and subxiphoid views were 5 (95% CI, 4.88-5.1), 4.7 (95% CI, 4.59-4.8), 5.1 (95% CI, 4.96-5.24), and 3.7 (95% CI 3.6-3.8) respectively.

Conclusion: This study demonstrated that when constructive feedback on each FAST exam was given, the average first-year emergency medicine resident achieves competency in performing FAST exams independently after completing 10-12 (average of 11.23) FAST exams. Further research is required to validate the findings.

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来源期刊
CiteScore
4.60
自引率
0.00%
发文量
63
审稿时长
13 weeks
期刊介绍: The aim of the journal is to bring to light the various clinical advancements and research developments attained over the world and thus help the specialty forge ahead. It is directed towards physicians and medical personnel undergoing training or working within the field of Emergency Medicine. Medical students who are interested in pursuing a career in Emergency Medicine will also benefit from the journal. This is particularly useful for trainees in countries where the specialty is still in its infancy. Disciplines covered will include interesting clinical cases, the latest evidence-based practice and research developments in Emergency medicine including emergency pediatrics.
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