Ability of non-physicians to perform and interpret lung ultrasound: A systematic review.
Varsha Swamy, Philip Brainin, Tor Biering-Sørensen and 1 others
PMID 31018658WHAT IT FOUND
Nurses and many students could learn to identify lung congestion signs and pleural effusions on ultrasound after short training, but one paramedic study failed.
This does not prove better patient care.
Key findings
01Compared with expert review or expert-performed ultrasound, nurse-performed lung ultrasound detected pleural effusions with sensitivity ranging from 88% to 92% and specificity from 93% to 99%.
02After training, students' correct answers on a lung ultrasound interpretation test increased from 42.1% to 82.6%, but in another study 48% of images were still considered inadequate.
03In the paramedic study, 59% of examinations were deemed uninterpretable, and the study did not meet its pre-defined endpoint of a >80% rate of interpretable images.
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The review included a small number of studies with small samples. Training time, number of lung zones, definitions of a positive exam and reference standards varied across studies, so results are hard to compare. Some student studies did not report how much training was for lung ultrasound alone. One study assessed diagnostic accuracy using only images deemed acceptable by the expert sonographer. The paramedic evidence came from one study, and that study did not meet its pre-defined endpoint of a >80% rate of interpretable images.
Declared interests
The authors declared no conflict of interest. The publication types list research support from N.I.H., Extramural.
The easy way to misread this
Do not conclude that nurse-performed lung ultrasound improves patient outcomes. The included studies reported image adequacy and diagnostic accuracy, and one paramedic study failed its pre-defined endpoint of a >80% rate of interpretable images.