The Accuracy of the Learning-Curve Cumulative Sum Method in Assessing Brachial Plexus Block Competency
Authors' conclusion
The LC-CUSUM and RA-LC-CUSUM methods were associated with substantial false-positive and false-negative rates.
Study context
- Population
- Anesthesia residents performing brachial plexus blocks (BPBs)1,713 BPB
- Participants
- 32 residents
- Comparison
- Learning-curve cumulative sum method (LC-CUSUM) vs RA-LC-CUSUM for assessing brachial plexus block competency
- Outcome
- Accuracy of LC-CUSUM forms vs reference competency (maximum 15% cumulative failure rate)
Methodological detailshistorical data, multilevel logistic regression risk adjustment
- Historical data
- Multilevel logistic regression risk adjustment
Performance
As reported in the abstract
Accuracy for competency
| Test or model | Sensitivity | Specificity |
|---|---|---|
| LC-CUSUM | 85% (95% CI, 71%-98%)Sensitivity on a scale from 0 to 100 percent | 67% (95% CI, 29%-100%)Specificity on a scale from 0 to 100 percent |
| RA-LC-CUSUM | 77% (95% CI, 61%-93%)Sensitivity on a scale from 0 to 100 percent | 67% (95% CI, 29%-100%)Specificity on a scale from 0 to 100 percent |
Sensitivity
LC-CUSUM85% (95% CI, 71%-98%)
RA-LC-CUSUM77% (95% CI, 61%-93%)
Sensitivity on a scale from 0 to 100 percentSpecificity
LC-CUSUM67% (95% CI, 29%-100%)
RA-LC-CUSUM67% (95% CI, 29%-100%)
Specificity on a scale from 0 to 100 percent- RA-LC-CUSUM vs LC-CUSUM: P = 0.15 — similar
- RA-LC-CUSUM vs LC-CUSUM: P = 1 — identical
Further findings
Residents attaining competency and blocks needed
P = 0.001
Median blocks to competency LC-CUSUM 18.5 (IQR, 14-23) · RA-LC-CUSUM 17.5 (IQR, 14-25)
Median
| Outcome | LC-CUSUM | RA-LC-CUSUM | P value |
|---|---|---|---|
| Failure rate at reaching competency | 6.5% (IQR 4%–9.75%) | 6.5% (IQR 4%–9%) | P = 0.37 |
Original publication
The Accuracy of the Learning-Curve Cumulative Sum Method in Assessing Brachial Plexus Block Competency. Anesth Analg. Published 11 June 2024. doi:10.
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