Use of Cardiac Point-of-Care Ultrasound in the Pediatric Emergency Department

Abstract

Objectives: We sought to describe the test characteristics of cardiac point-of-care ultrasound (POCUS) performed by pediatric emergency medicine (PEM) physicians after structured cardiac POCUS training. Methods: We evaluated the use of clinically indicated cardiac POCUS by PEM physicians in a single tertiary care pediatric emergency department after implementation of a focused cardiac POCUS training curriculum. The test characteristics of the sonologist interpretation were compared with expert POCUS review, by PEM physicians who have completed PEM POCUS fellowship training, for the assessment of both pericardial effusion and left ventricular systolic dysfunction.Results: A total of 1241 cardiac POCUS examinations were performed between July 2015 and December 2017, of which 456 were clinically indicated and underwent expert POCUS review and comprised the study sample. These examinations were performed by 33 different PEM attending sonologists. Chest pain (52%), dyspnea (20%), and tachycardia (18%) were the most common indications for cardiac POCUS. Prevalence of pericardial effusion and global systolic dysfunction based on expert POCUS review were 11% (48/443) and 4% (16/435), respectively. Real-time cardiac POCUS interpretation had a sensitivity and specificity of 100% and 99.5%, respectively, for both pericardial effusion and left ventricular systolic dysfunction when compared with expert POCUS review.Conclusions: Cardiac POCUS is both sensitive and specific for identifying pericardial effusion and left ventricular systolic dysfunction when performed by PEM attendings with focused training.

Multisystem inflammatory syndrome in children with COVID-19

“…As these patients are often toxic appearing and present similar to those with septic shock, broad spectrum antibiotics are recommended, with blood cultures obtained prior to antibiotic therapy when feasible. Given the potential for cardiogenic versus vasodilatory shock, point-of-care ultrasound should be performed prior to aggressive volume resuscitation [ 58 ]. Patients who are volume depleted based on either clinical examination or ultrasound should receive fluid resuscitation [ 59 ].…”

Diagnostic Utility of Point-of-Care Ultrasound in the Pediatric Cardiac Intensive Care Unit

“…Several studies demonstrated that, after a short training, assessment of LV function by non-cardiologist physicians was strongly correlated to that made by a pediatric cardiologist [6,12,13]. Similarly, Miller et al [14] demonstrated that POCUS was highly sensitive and specific for LV systolic dysfunction in pediatric patients. In 2014, the American Society of Echocardiography (ASE) strongly recommended the use of cardiac POCUS in critically ill patients for specific scenarios, including evaluation of gross ventricular systolic function and cardiac arrest [15].…”

“…Adult and pediatric studies have consistently demonstrated the accuracy by which non-cardiologists can identify pericardial effusions and cardiac tamponade by cardiac ultrasound [12,13,39,40]. Miller et al [14] demonstrated that cardiac POCUS was highly sensitive and specific for pericardial effusions in pediatric patients after a focused ultrasound training. In fact, the ASE strongly recommended the use of cardiac POCUS to assess for pericardial effusions in children [15].…”

Subcostal Echocardiographic Imaging in Neonatal and Pediatric Intensive Care

“…FOCUS is both, sensitive and specific for identifying pericardial effusion and left ventricular systolic dysfunction when performed by non-experts with appropriate training ( 24 ). The latter, of course, is of major importance and needs to be updated regularly on a structured basis ( 25 , 26 ).…”