• Chiara Robba, Daniele Poole, Giuseppe Citerio, Fabio S Taccone, Frank A Rasulo, and Consensus on brain ultrasonography in critical care group.
• Department of Anaesthesia and Intensive Care, Ospedale Policlinico San Martino IRCCS, Genoa, Italy.
• Neurocrit Care. 2020 Apr 1; 32 (2): 502-511.

BackgroundTo report a consensus on the different competency levels for the elaboration of skill recommendations in performing brain ultrasonography within the neurocritical care setting.MethodsFour brain ultrasound experts, supported by a methodologist, performed a preselection of indicators and skills based on the current literature and clinical expertise. An international panel of experts was recruited and subjected to web-based questionnaires according to a Delphi method presented in three separate rounds. A pre-defined threshold of agreement was established on expert subjective opinions, > 84% of votes was set to support a strong recommendation and > 68% for a weak recommendation. Below these thresholds, no recommendation reached.ResultsWe defined four different skill levels (basic, basic-plus, pre-advanced, advanced). Twenty-five experts participated to the full process. After four rounds of questions, two items received a strong recommendation in the basic skill category, three in the advanced, twelve in the basic-plus, and seven in the pre-advanced. Two items in the pre-advanced category received a weak recommendation and three could not be collocated and were excluded from the list.ConclusionsResults from this consensus permitted stratification of the different ultrasound examination skills in four levels with progressively increasing competences. This consensus can be useful as a guide for beginners in brain ultrasonography and for the development of specific training programs within this field.

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