Abstract: FR-OR005

Renal Fellows’ Point-of-Care Lung Ultrasound Curriculum

Session Information

Category: Nephrology Education

  • 1301 Educational Research

Authors

  • Reisinger, Nathaniel C., Penn, Philadelphia, Pennsylvania, United States
  • Kumar, Anubhav, Penn, Philadelphia, Pennsylvania, United States
  • Potluri, Vishnu S., Penn, Philadelphia, Pennsylvania, United States
  • Bahrainwala, Jehan Z., Penn, Philadelphia, Pennsylvania, United States
  • Berns, Jeffrey S., Penn, Philadelphia, Pennsylvania, United States
Background

Fluid overload (FO) is a prevalent risk factor for death in patients on hemodialysis (HD) and is underdiagnosed. Lung ultrasound (US) B-line score is a tool to quantify extravascular lung water and measure FO. B-lines are reverberation artifacts that correlate with lung congestion and disappear with ultrafiltration during HD. B-line score is superior to physical exam in detection of asymptomatic pulmonary congestion. B-line score correlates with cardiovascular outcomes, death, and readmissions for patients on HD. A prospective clinical trial is ongoing which uses a web-based tutorial to ensure interobserver agreement among attending physicians. Competency among nephrology fellows is not known.

Methods

To assess and improve the current state of knowledge and ability of nephrology fellows in obtaining and interpreting lung US we employed a mobile-optimized, app-supported curriculum for didactic learning as well as pre- and post-course surveys (using a 5-point Likert Scale) and knowledge assessments. Trainees had a hands-on, one-on-one teaching session with a peer-user to hone psychomotor skills in point-of-care lung US. Images were obtained using a commercially available curvilinear US probe and a tablet computer. A panel of expert trainers reviewed representative images remotely, provided feedback on image acquisition, and adjudicated B-line scores. Scores were compared using a paired two sample means t-Test with a one-tailed p value. Interclass correlation coefficients were calculated in Stata.

Results

Surveys demonstrated statistically significant increases in confidence in five domains critical to point-of-care US. Mean knowledge assessment score was 4% before the course and 92% after the course. Interclass correlation coefficients averaged 0.90 with no scores below 0.7 demonstrating excellent agreement in interpreting B-line scores which was confirmed on regression analysis. Bland-Altman plot showed good agreement and low bias. User images were well-reviewed by the expert trainers.

Conclusion

Point-of-care US to quantify lung water by B-line score can be taught to nephrology fellows quickly and reliably combining a web-based curriculum and hands-on training.