Assessment of a training curriculum for emergency ultrasound for pediatric soft tissue infections

The objective was to evaluate a training protocol for pediatric emergency physicians (EPs) learning emergency ultrasound (EUS) for the evaluation of skin and soft tissue infections (SSTIs) by assessing technical ability and interrater reliability.

Pediatric emergency medicine (EM) fellows and attending physicians completed a 1-day training course taught by an expert emergency sonologist. After the course, EPs performed proctored examinations on patients with SSTIs until they reached predefined performance criteria, after which they performed independent EUS examinations. All EUS examinations were recorded using still images and video clips that were reviewed and rated by the expert sonologist on four technical measures and combined into a composite score. The expert's opinion regarding the presence or absence of an abscess was also compared to the study sonologist's opinion and analyzed for interrater reliability.

Seven EPs performed 107 EUS examinations. The mean (±SD) composite score for the evaluation of technical ability for the first EUS was 3.3 ± 0.14 (on a 4-point scale), indicating a high level of quality following the training course. There was a small amount of improvement in the quality score (0.015, 95% confidence interval [CI] = 0.0003 to 0.03) with each consecutive EUS examination. The interrater reliability between the sonologist and the expert for the presence of an abscess as measured by the kappa statistic was 0.80 (95% CI = 0.63 to 0.97), indicating substantial agreement.

After a brief training program, pediatric EPs can perform technically successful emergency EUS examination of SSTIs, with excellent agreement with an expert sonologist.