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Brain Ultrasonography Consensus on Skill Recommendations and Competence Levels Within the Critical Care Setting

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Abstract

Background

To report a consensus on the different competency levels for the elaboration of skill recommendations in performing brain ultrasonography within the neurocritical care setting.

Methods

Four brain ultrasound experts, supported by a methodologist, performed a preselection of indicators and skills based on the current literature and clinical expertise. An international panel of experts was recruited and subjected to web-based questionnaires according to a Delphi method presented in three separate rounds. A pre-defined threshold of agreement was established on expert subjective opinions, > 84% of votes was set to support a strong recommendation and > 68% for a weak recommendation. Below these thresholds, no recommendation reached.

Results

We defined four different skill levels (basic, basic-plus, pre-advanced, advanced). Twenty-five experts participated to the full process. After four rounds of questions, two items received a strong recommendation in the basic skill category, three in the advanced, twelve in the basic-plus, and seven in the pre-advanced. Two items in the pre-advanced category received a weak recommendation and three could not be collocated and were excluded from the list.

Conclusions

Results from this consensus permitted stratification of the different ultrasound examination skills in four levels with progressively increasing competences. This consensus can be useful as a guide for beginners in brain ultrasonography and for the development of specific training programs within this field.

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Collaborators

The Consensus on brain ultrasonography in critical care group participants: Marcel Aries: Dep. of Neurosurgical Critical Care, University of Groningen, the Netherlands, Rafael Badenes: Hospital Clínico Universitario de Valencia, Spain, Judith Bellapart: Neuro Intensive Care, University of Queensland, Queensland, Australia, Pierre Bouzat: Pôle Anesthésie Réanimation, University of Grenoble, Grenoble France, Danilo Cardim: University of British Columbia, Vancouver, Canada, Andre Denault: l’Institut de cardiologie de Montréal, Université de Montréal, Canada, Jamil R. Dibu: Respiratory & Critical Care Institute, Cleveland Clinic, Abu Dhabi, UAE, Thomas Geeraerts: Dep. of Anesthesiology and Critical Care, University Hospital of Toulouse, France, Alberto Goffi: Department of Medicine, Division of Resp. Critical Care), University Health Network, Toronto, Canada, Ryan Hakim: Columbia Presbyterian University Hospital, New York, USA, Massimo Lamperti: Respiratory & Critical Care Institute, Cleveland Clinic, Abu Dhabi, UAE, Victoria McCredei: Neurocritical care, Toronto Western Hospital, Toronto, Canada, Llewellyn Padayachy: Department of Child and Adolescent Health, University of Pretoria, South Africa, Soojin Park:Columbia Presbyterian University Hospital, New York, USA, Hemanshu Prabhakar: Institute of Medical Sciences, New Delhi (AIIMS), India, Corina Puppo: Critical Care Unit, Montevideo, Uruguay, Andrea Rigamonti: Trauma-Neuro Intensive Care Unit, St. Michael’s Hospital, Toronto, Canada, Aarti Sarwal: Wake Forest Baptist Health Center, Winston Salem, NC, USA, Mypinder Sekhon: Neurointensive Care, Vancouver General Hospital, Canada, Luzius Steiner: University Hospital Lausanne, Lausanne, Switzerland, Carol Turner: Addenbrooke’s Hospital, Cambridge, UK.

Funding

No financial Support. Endorsed by the Neuro Critical Care Society.

Author information

Author notes

  1. Chiara Robba, Daniele Poole, Giuseppe Citerio, Fabio S. Taccone and Frank A. Rasulo contributed equally to the elaboration of this paper.

Authors and Affiliations

  1. Department of Anaesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS, Genoa, Italy

    Chiara Robba

  2. Anesthesia and Intensive Care Operative Unit, S. Martino Hospital, Belluno, Italy

    Daniele Poole

  3. School of Medicine and Surgery, University of Milano Bicocca, Milan, Italy

    Giuseppe Citerio

  4. Department of Intensive Care Medicine, Erasme Hospital, Université Libre de Bruxelles, Brussels, Belgium

    Fabio S. Taccone

  5. Department of Anaesthesia, Intensive Care and Emergency Medicine, Spedali Civili University Hospital of Brescia, University of Brescia, Brescia, Italy

    Frank A. Rasulo

Authors
  1. Chiara Robba
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  2. Daniele Poole
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  3. Giuseppe Citerio
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Consortia

the Consensus on brain ultrasonography in critical care group

  • Marcel Aries
  • , Rafael Badenes
  • , Judith Bellapart
  • , Pierre Bouzat
  • , Danilo Cardim
  • , Andre Denault
  • , Jamil R. Dibu
  • , Thomas Geeraerts
  • , Alberto Goffi
  • , Ryan Hakim
  • , Massimo Lamperti
  • , Victoria McCredei
  • , Llewellyn Padayachy
  • , Soojin Park
  • , Hemanshu Prabhakar
  • , Corina Puppo
  • , Andrea Rigamonti
  • , Aarti Sarwal
  • , Mypinder Sekhon
  • , Luzius Steiner
  •  & Carol Turner

Contributions

FR, CR designed the study. FR, CR, GC, and FT drafted the article. CR, GC collected the data. DP performed the statistical analysis. GC served as time manager. All authors participated in interpreting the data. FR, CR wrote and edited the article. From the Consensus on brain ultrasound in critical care group participants some of the experts have participated in answering the consensus questionnaires in various rounds.

Corresponding author

Correspondence to Frank A. Rasulo.

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Conflict of interest

The author declares that they have no conflict of interest.

Ethical Approval/Informed Consent

Since this paper addresses a consensus performed through a Delphi process (experts exposed to questionnaires) and does not involve patients or patients data, niether Ethical nor Informed Consent was necessary.

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Robba, C., Poole, D., Citerio, G. et al. Brain Ultrasonography Consensus on Skill Recommendations and Competence Levels Within the Critical Care Setting. Neurocrit Care 32, 502–511 (2020). https://doi.org/10.1007/s12028-019-00766-9

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  • DOI: https://doi.org/10.1007/s12028-019-00766-9

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