Learning Curve of Ultrasound Cardiac Output Monitor among Trained Pediatric Residents
Putu Aditya Wiguna,Desy Rusmawatiningtyas,Indah Kartika Murni
Departement of Child Health, DrSardjito HospitalFaculty of Medicine, Public Health, and Nursing, Gadjah Mada University
Background : Ultrasound Cardiac Output Monitor (USCOM) had a relatively short learning curve for various health professionals. Novice only needs 20 training examinations to attain comparable results with the expert. Learning curve among pediatric residents after training examination needs to be assessed. The objective of this study is to assess the learning curve of USCOM measurement between pediatric resident and pediatric intensivist.
Material : We conducted a prospective observational study in the Pediatric Intensive Care Unit (PICU) during February-April 2018, consecutively involving patients aged one month - 18 years. The pediatric intensivist performed trans-aortic USCOM measurements, then paired with one of the two randomly selected pediatric residents who underwent 20 training examinations. Blinded measurements were obtained from the same patient within 15 minutes. Mean percentage differences of cardiac index (CI) were compared with Mann-Whitney U test. Learning curve trend was measured by linear regression.
Results : Forty-eight paired measurements were performed. The median (minimum-maximum) age was 2 years old (1 month-17 years old). The most common underlying disease was neurological in 50% patients. Mean percentage difference of CI between pediatric residents was not statistically significant (p=0.09). The paired measurement of CI between pediatric intensivist and pediatric residents was comparable, with the median of percentage difference was 8.1% (3.48-25.75). Despite the improving trend of mean (±SD) percentage difference from first five scans (14.28% ±7.95) compared to last five scans (9.6% ± 8.67), those were not statistically significant (p=0.25). Learning curve showed a flat trend with linear regression equation (y = -0.32x + 15.75).
Conclusions : The learning curve of USCOM examination showed plateau form. Trained pediatric residents can produce equal results for USCOM examination compared to pediatric intensivist.
Keywords: USCOM Learning Curve Cardiac Index
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