Validation of a skills assessment scoring system for transesophageal echocardiographic monitoring of hemodynamics.
OBJECTIVE
Transesophageal echocardiography (TEE) is increasingly used in hemodynamic monitoring in the intensive care unit. This paper describes and validates a scoring system for assessing competence in TEE performed by intensivists for this indication.


METHODS
Prospective study over an 18-month period.


METHODS
Two medical intensive care units.


METHODS
The scoring system is used to assess four aspects of TEE: quality of the views (score out of 14); semiquantitative evaluation of respiratory variations in the superior vena cava, valve regurgitation, size of the right ventricle (score out of 10); accuracy of measurement of velocity-time integrals for pulmonary and aortic flow, peak velocity of the E and A waves of mitral flow, left ventricular fractional area change (score out of 8); summary and proposed treatment (score out of 8). The scoring system was validated by using it to assess intensivists after 1 month (M1), 3 months (M3) and 6 months (M6) of training. TEE was done on a mechanically ventilated, hypotensive patient and scored by comparing the intensivist's examination with that of the expert examiner. The intensivists were divided into two groups of theoretical expertise at the start of training.


RESULTS
Nineteen intensivists were evaluated. The scores at M1 for level 0 (no experience in echocardiography) and level 1 (previous experience) were, respectively, 18.5 +/- 4 and 24.7 +/- 5. The scores at M1, M3, and M6 were, respectively, 20.4 +/- 5, 30.4 +/- 5 and 35.7 +/- 3. At M6, the intensivists had performed TEE 29 +/- 10 times.


CONCLUSIONS
The scoring system was discriminatory and sensitive to change, and could be used as a tool to assess an intensivist's mastery of TEE.
Charron
Cyril
C
Medical Intensive Care Unit, University Hospital Ambroise Paré, 9 avenue Charles de Gaulle, 92104, Boulogne Cedex, France.
Prat
Gwenaël
G
Caille
Vincent
V
Belliard
Guillaume
G
Lefèvre
Montaine
M
Aegerter
Philippe
P
Boles
Jean-Michel
JM
Jardin
François
F
Vieillard-Baron
Antoine
A
D002983:Clinical Competence; D017548:Echocardiography, Transesophageal; D006439:Hemodynamics; D006801:Humans; D007362:Intensive Care Units; D019095:Point-of-Care Systems; D011446:Prospective Studies
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