• Arvind Rajamani, Louise Smith, Sutrisno Gunawan, Gunawan Gunawan, Jinal Parmar, Hemamalini Arvind, Stephen Huang, and SPARTAN Collaborative (Small Projects, Audits and Research Projects-Australia/New Zealand).
• Nepean Clinical School, University of Sydney, Kingswood, NSW, Australia; Department of Intensive Care Medicine, Nepean Hospital, Kingswood, NSW, Australia. Electronic address: rrarvind@hotmail.com.
• Chest. 2021 Aug 1; 160 (2): 616-623.

BackgroundThe formulation of expert opinion guidelines has several sources of bias that may adversely affect their quality. To minimize bias, guideline creators must use rigorous methodology. There has been no appraisal of the methodologic quality of basic critical care echocardiography (BCCE) training/education guidelines.Research QuestionWhat is the methodologic quality of expert guidelines/recommendations on BCCE training?Study Design And MethodsThe review was performed by a multidisciplinary team including intensive care specialists, a hospital scientist, a trainee, a nurse sonographer, and a public health expert. Four databases (PubMed, OVID-Embase, Clarivate Analytics Web of Science, and Google Scholar) were searched on July 31, 2020, to identify guidelines on BCCE training/education. Every guideline was assessed subjectively for the degree of detail of the recommendations and assessed objectively by using the AGREE-II critical appraisal tool for clinical practice guidelines to generate a scaled domain score. A score ≥ 75% in every domain was the cut off for guidelines to be used without modifications.ResultsFrom 4,288 abstracts screened, 24 guidelines met the inclusion criteria. Very few guidelines made clear recommendations regarding introductory courses: physics (n = 6 [25%]), instrumentation (n = 5 [20.8%]), image acquisition theory (n = 6 [25%]), course curriculum (n = 5 [[20.8%]), pre-course/post-course tests (n = 1 [4.2%]), minimum course duration (n = 6 [25%]), or trainer qualifications (n = 5 [20.8%]). Very few provided clear recommendations for longitudinal competence programs: clinically indicated scans (n = 8 [33.3%]), logbook (n = 14 [58.3%]), image storage (n = 9 [37.5%]), formative assessment (n = 6 [25%]), minimum scan numbers (n = 14 [58.3%]), image acquisition competence (n = 3 [12.5%]), image interpretation competence (n = 2 [8.3%]), and credentialing/certification (n = 3 [12.5%]). Five guidelines (20.8%) attained a scaled overall AGREE-II score ≥ 75%. One guideline (4.2%) attained scores ≥ 75% in every domain.InterpretationThe methodologic appraisal of BCCE-training guidelines showed widespread deficiencies in guideline formulation processes. The impact of these deficiencies on the validity of the recommendations requires further evaluation in longitudinal studies.Copyright © 2021 American College of Chest Physicians. All rights reserved.

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