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



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


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.


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.


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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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.


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

Author information





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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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).

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  • Brain ultrasound
  • Training
  • Intensive care
  • Acute brain injury
  • Consensus
  • Delphi