Jorge E Lopez Matta, Micah L A Heldeweg, Luigi Pisani, Carlos V Elzo Kraemer, Stefanie Slot, Mark E Haaksma, Jasper M Smit, Amne Mousa, Giovanna Magnesa, Fabrizia Massaro, Hugo R W Touw, Viviane Schouten, Pieter R Tuinman, David J van Westerloo
{"title":"胸部超声相关的管理变化：预测因素和操作员认证的作用（奥特曼的二次分析）。","authors":"Jorge E Lopez Matta, Micah L A Heldeweg, Luigi Pisani, Carlos V Elzo Kraemer, Stefanie Slot, Mark E Haaksma, Jasper M Smit, Amne Mousa, Giovanna Magnesa, Fabrizia Massaro, Hugo R W Touw, Viviane Schouten, Pieter R Tuinman, David J van Westerloo","doi":"10.1002/jcu.70104","DOIUrl":null,"url":null,"abstract":"<p><strong>Objectives: </strong>To investigate which patient characteristics, ultrasound operator certification level, and thoracic ultrasound (TUS) examination findings are associated with a TUS-induced change in clinical management in adult intensive care unit (ICU) patients.</p><p><strong>Design: </strong>Post hoc analysis of a prospective international observational study (UltraMan study) on the impact of thoracic ultrasound on clinical management of critically ill patients. The first TUS examinations of each patient included in the study were included in this analysis. Multivariable logistic regression was performed to identify which patient characteristic(s), operator certification level, or TUS-related factors were significantly associated with a change in management.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The first TUS examinations of each of the 534 patients were included in this analysis. TUS led to management changes in almost half of the patients in whom a TUS was performed (44.6%). TUS-induced management changes were significantly associated with patient characteristics. Specifically, a medical history of cardiovascular disease demonstrated a significant association (OR: 1.73; 95% CI: 1.12-2.68). In terms of TUS examination findings, hypovolemia demonstrated a significant association with a change in management (OR: 2.05; 95% CI: 1.10-3.80). No significant association was found between ultrasound operator certification level and changes in management driven by TUS.</p><p><strong>Conclusions: </strong>This study indicates that TUS was associated with management changes in 44.6% of ICU patients, with stronger associations in those with cardiovascular disease and hypovolemia, and no detectable effect of operator certification in adjusted analyses. As a post hoc analysis of an observational cohort, these findings warrant cautious interpretation and underscore the importance of competency-based training and quality assurance.</p>","PeriodicalId":15386,"journal":{"name":"Journal of Clinical Ultrasound","volume":" ","pages":""},"PeriodicalIF":1.4000,"publicationDate":"2025-10-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Thoracic Ultrasound-Related Management Change: Predictors and the Role of Operator Certification (Secondary Analysis of UltraMAN).\",\"authors\":\"Jorge E Lopez Matta, Micah L A Heldeweg, Luigi Pisani, Carlos V Elzo Kraemer, Stefanie Slot, Mark E Haaksma, Jasper M Smit, Amne Mousa, Giovanna Magnesa, Fabrizia Massaro, Hugo R W Touw, Viviane Schouten, Pieter R Tuinman, David J van Westerloo\",\"doi\":\"10.1002/jcu.70104\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Objectives: </strong>To investigate which patient characteristics, ultrasound operator certification level, and thoracic ultrasound (TUS) examination findings are associated with a TUS-induced change in clinical management in adult intensive care unit (ICU) patients.</p><p><strong>Design: </strong>Post hoc analysis of a prospective international observational study (UltraMan study) on the impact of thoracic ultrasound on clinical management of critically ill patients. The first TUS examinations of each patient included in the study were included in this analysis. Multivariable logistic regression was performed to identify which patient characteristic(s), operator certification level, or TUS-related factors were significantly associated with a change in management.</p><p><strong>Interventions: </strong>None.</p><p><strong>Measurements and main results: </strong>The first TUS examinations of each of the 534 patients were included in this analysis. TUS led to management changes in almost half of the patients in whom a TUS was performed (44.6%). TUS-induced management changes were significantly associated with patient characteristics. Specifically, a medical history of cardiovascular disease demonstrated a significant association (OR: 1.73; 95% CI: 1.12-2.68). In terms of TUS examination findings, hypovolemia demonstrated a significant association with a change in management (OR: 2.05; 95% CI: 1.10-3.80). No significant association was found between ultrasound operator certification level and changes in management driven by TUS.</p><p><strong>Conclusions: </strong>This study indicates that TUS was associated with management changes in 44.6% of ICU patients, with stronger associations in those with cardiovascular disease and hypovolemia, and no detectable effect of operator certification in adjusted analyses. 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Thoracic Ultrasound-Related Management Change: Predictors and the Role of Operator Certification (Secondary Analysis of UltraMAN).
Objectives: To investigate which patient characteristics, ultrasound operator certification level, and thoracic ultrasound (TUS) examination findings are associated with a TUS-induced change in clinical management in adult intensive care unit (ICU) patients.
Design: Post hoc analysis of a prospective international observational study (UltraMan study) on the impact of thoracic ultrasound on clinical management of critically ill patients. The first TUS examinations of each patient included in the study were included in this analysis. Multivariable logistic regression was performed to identify which patient characteristic(s), operator certification level, or TUS-related factors were significantly associated with a change in management.
Interventions: None.
Measurements and main results: The first TUS examinations of each of the 534 patients were included in this analysis. TUS led to management changes in almost half of the patients in whom a TUS was performed (44.6%). TUS-induced management changes were significantly associated with patient characteristics. Specifically, a medical history of cardiovascular disease demonstrated a significant association (OR: 1.73; 95% CI: 1.12-2.68). In terms of TUS examination findings, hypovolemia demonstrated a significant association with a change in management (OR: 2.05; 95% CI: 1.10-3.80). No significant association was found between ultrasound operator certification level and changes in management driven by TUS.
Conclusions: This study indicates that TUS was associated with management changes in 44.6% of ICU patients, with stronger associations in those with cardiovascular disease and hypovolemia, and no detectable effect of operator certification in adjusted analyses. As a post hoc analysis of an observational cohort, these findings warrant cautious interpretation and underscore the importance of competency-based training and quality assurance.
期刊介绍：
The Journal of Clinical Ultrasound (JCU) is an international journal dedicated to the worldwide dissemination of scientific information on diagnostic and therapeutic applications of medical sonography.
The scope of the journal includes--but is not limited to--the following areas: sonography of the gastrointestinal tract, genitourinary tract, vascular system, nervous system, head and neck, chest, breast, musculoskeletal system, and other superficial structures; Doppler applications; obstetric and pediatric applications; and interventional sonography. Studies comparing sonography with other imaging modalities are encouraged, as are studies evaluating the economic impact of sonography. Also within the journal''s scope are innovations and improvements in instrumentation and examination techniques and the use of contrast agents.
JCU publishes original research articles, case reports, pictorial essays, technical notes, and letters to the editor. The journal is also dedicated to being an educational resource for its readers, through the publication of review articles and various scientific contributions from members of the editorial board and other world-renowned experts in sonography.
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