Development and validation of an assessment tool for adult simulated ultrasound-guided fascia iliaca block: a prospective monocentric study.

BACKGROUND: Fascia iliaca block (FIB) is an effective technique for analgesia. While FIB using ultrasound is preferred, there is no current standardised training technique or assessment scale. We aimed to create a valid and reliable tool to assess ultrasound-guided FIB. METHOD: This prospective observational study was conducted in the ABS-Lab simulation centre, University of Poitiers, France between 26-29 October and 14-17 December 2021. Psychometric testing included validity analysis and reliability between two independent observers. Content validity was established using the Delphi method. Three rounds of feedback were required to reach consensus. To validate the scale, 26 residents and 24 emergency physicians performed a simulated FIB on SIMLIFE, a simulator using a pulsated, revascularised and reventilated cadaver. Validity was tested using Cronbach's α coefficient for internal consistency. Comparative and Spearman's correlation analysis was performed to determine whether the scale discriminated by learner experience with FIB and professional status. Reliability was analysed using the intraclass correlation (ICC) coefficient and a correlation score using linear regression (R2). RESULTS: The final 30-item scale had 8 parts scoring 30 points: patient positioning, preparation of aseptic and tools, anatomical and ultrasound identification, local anaesthesia, needle insertion, injection, final ultrasound control and signs of local anaesthetic systemic toxicity. Psychometric characteristics were as follows: Cronbach's α was 0.83, ICC was 0.96 and R2 was 0.91. The performance score was significantly higher for learners with FIB experience compared with those without experience: 26.5 (22.0; 29.0) vs 22.5 (16.0; 26.0), respectively (p=0.02). There was a significant difference between emergency residents' and emergency physicians' scores: 20.5 (17.0; 25.0) vs 27.0 (26.0; 29.0), respectively (p=0.0001). The performance was correlated with clinical experience (Rho=0.858, p<0.0001). CONCLUSION: This assessment scale was found to be valid, reliable and able to identify different levels of experience with ultrasound-guided FIB.

Automated 3D Rendering of Ribs in 110 Polytrauma Patients: Strengths and Limitations.

RATIONALE AND OBJECTIVES: To evaluate the strengths and limitations of a rib-unfolding software in a polytrauma context. MATERIALS AND METHODS: Chest computed tomography (CT) examinations of 110 patients were reviewed for specific detection of rib fractures using: (1) transverse CT sections ± multiplanar reformattings (ie, the standard of reference), and (2) unfolded rib images reconstructed by the CT Bone Reading software with the possibility of rib analysis along their long axis and creation of standard orthogonal views in different orientations of any area suspected of fracture. RESULTS: The software provided complete reconstruction of the whole rib cage in 94 patients (85.5%) and partially incomplete reconstruction in 16 patients (14.5%). The percentage of ribs inadequately reconstructed was 1.5% (40 of 2640 ribs), mainly related to unfused epiphyses (13 of 40), costal hypoplasia (8 of 40), and vertebral fracture (6 of 40). The sensitivity and specificity in detecting rib fractures at a per-patient, per-rib, and per-costal arc level ranged from 0.73 to 0.84 and 0.99 to 1, respectively. At a costal arc level, the reader's misinterpretations accounted for 67% (4 of 6) of false-positive and 24% (20/84) of false-negative results, and interpretive difficulties were encountered for single-cortex fractures or fractures at the extremities of the costal shaft. CONCLUSIONS: An accurate diagnosis of rib fracture was achieved with the reading of unfolded rib images. In a polytrauma context, the evaluated system could facilitate rib analysis.