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Development and validation of an assessment tool for adult simulated ultrasound-guided fascia iliaca block: a prospective monocentric study
  1. Frederic-Pierre Guyader1,
  2. Mathieu Violeau2,
  3. Jérémy Guenezan3,4,
  4. Youcef Guechi5,
  5. Cyril Breque6,
  6. Pauline Betoulle-Masset4,
  7. Jean-Pierre Faure7,8,
  8. Denis Oriot9,10,
  9. Daniel Aiham Ghazali11,12
  1. 1 Hospital European George Pompidou, Paris, France
  2. 2 Hospital Centre Niort, Niort, France
  3. 3 Emergency Department and Prehospital Care, CHU Poitiers, Poitiers, France
  4. 4 ABS-Lab, Poitiers University Faculty of Medicine and Pharmacy, Poitiers, France
  5. 5 Emergency Department, Fribourg Hospitals, Fribourg, Switzerland
  6. 6 Simulation Center, Poitiers University Faculty of Medicine and Pharmacy, Poitiers, France
  7. 7 Anatomy Laboratory, Poitiers University Faculty of Medicine and Pharmacy, Poitiers, France
  8. 8 General Surgery, CHU Poitiers, Poitiers, France
  9. 9 Simulation Laboratory, Poitiers University Faculty of Medicine and Pharmacy, Poitiers, France
  10. 10 Pediatric Emergency Department, CHU Poitiers, Poitiers, France
  11. 11 Emergency Department, University Hospital Centre Amiens-Picardie, Amiens, France
  12. 12 Amiens University, Amiens, France
  1. Correspondence to Professor Daniel Aiham Ghazali, Department of Emergency, University Hospital Centre Amiens-Picardie, Amiens, France; aiham{at}


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.

  • local
  • analgesia
  • pain management
  • research
  • assessment

Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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Data availability statement

Data are available on reasonable request. All data relevant to the study are included in the article or uploaded as supplementary information.

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  • Handling editor David Metcalfe

  • Contributors (CRediT taxonomy) Conceptualisation: DAG: ideas; F-PG and DAG: formulation or evolution of overarching research goals and aims. Methodology: DAG: development or design of methodology; F-PG and DAG: creation of the tool. MV, YG, JG, J-PF and DO: revision of the scale. Validation: J-PF and DO: verification, whether as a part of the activity or separately, of the overall replication/ reproducibility of results/experiments and other research outputs. Formal analysis: DAG: application of statistical, mathematical, computational or other formal techniques to analyse or synthesise study data. Investigation: FG and DAG: conducting a research and investigation process, specifically performing the experiments or data/evidence collection. Resources: CB and PB-M: provision of study materials, reagents, materials, patients, laboratory samples, animals, instrumentation, computing resources or other analysis tools. Data curation: F-PG, MV and JG: management activities to annotate (produce metadata), scrub data and maintain research data (including software code, where it is necessary for interpreting the data itself) for initial use and later reuse. Writing—original draft: FG: preparation, creation and/or presentation of the published work, specifically writing the initial draft (including substantive translation). Writing—review and editing: DAG: preparation, creation and/or presentation of the published work by those from the original research group, specifically critical review, commentary or revision—including prepublication or postpublication stages. Supervision: DAG and DO: oversight and leadership responsibility for the research activity planning and execution, including mentorship external to the core team. Project administration: DAG: management and coordination responsibility for the research activity planning and execution. DAG is responsible for the overall content as the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests J-PF, DO, CB and DAG are co-inventors of patent no. 1000318748. SIMEDYS company has exclusive rights to exploit patent no. 1000318748. J-PF, J-PR, DO and CB are shareholders in SIMEDYS. P4P device which allows the revascularisation and reventilation of the cadaver is a trademark of SIMEDYS. All others authors declare that they have no conflict of interest.

  • Patient and public involvement statement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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