Evolution and Impact of a Diagnostic Point-of-Care Ultrasound Program in a PICU.
Journal
Pediatric critical care medicine : a journal of the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies
ISSN: 1529-7535
Titre abrégé: Pediatr Crit Care Med
Pays: United States
ID NLM: 100954653
Informations de publication
Date de publication:
18 Jul 2024
18 Jul 2024
Historique:
medline:
18
7
2024
pubmed:
18
7
2024
entrez:
18
7
2024
Statut:
aheadofprint
Résumé
To evaluate the impact of point-of-care ultrasound (POCUS) use on clinicians within a PICU and to assess infrastructural elements of our POCUS program development. Retrospective observational study. Large academic, noncardiac PICU in the United States. Patients in a PICU who had diagnostic POCUS performed. None. Between January 1, 2017, and December 31, 2022, 7201 diagnostic POCUS studies were ordered; 1930 (26.8%) had a quality assurance (QA) record generated in an independent POCUS QA database. The cardiac domain was most frequently imaged (81.0% of ordered studies, 81.2% of reviewed studies). POCUS images changed clinician understanding of pathophysiology in 563 of 1930 cases (29.2%); when this occurred, management was changed in 318 of 563 cases (56.5%). Cardiac POCUS studies altered clinician suspected pathophysiology in 30.1% of cases (472/1568), compared with 21.5% (91/362) in noncardiac studies (p = 0.06). Among cases where POCUS changed clinician understanding, management changed more often following cardiac than noncardiac POCUS (p = 0.02). Clinicians identified a need for cardiology consultation or complete echocardiograms in 294 of 1568 cardiac POCUS studies (18.8%). Orders for POCUS imaging increased by 94.9%, and revenue increased by 159.4%, from initial to final study year. QA database use by both clinicians and reviewers decreased annually as QA processes evolved in the setting of technologic growth and unit expansion. Diagnostic POCUS imaging in the PICU frequently yields information that alters diagnosis and changes management. As PICU POCUS use increased, QA processes evolved resulting in decreased use of our initial QA database. Modifications to QA processes are likely necessary as clinical contexts change over time.
Identifiants
pubmed: 39023322
doi: 10.1097/PCC.0000000000003581
pii: 00130478-990000000-00366
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Informations de copyright
Copyright © 2024 by the Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies.
Déclaration de conflit d'intérêts
Dr. Glau received funding from the Society of Critical Care Medicine. Dr. Himebauch’s institution received funding from the National Heart, Lung, and Blood Institute (K23 HL153759). Drs. Himebauch and Kaplan received support for article research from the National Institutes of Health (NIH). Dr. Keim disclosed that Timpel Medical loaned a medical device and provided supplies for a research study they participated in; he received support for article research from the Children’s Hospital of Philadelphia. Dr. Sutton’s institution received funding from the NIH. Dr. Nishisaki’s institution received funding from Chiesi USA. The remaining authors have disclosed that they do not have any potential conflicts of interest.
Références
Walker SB, Conlon TW, Zhang B, et al.: Clinical signs to categorize shock and target vasoactive medications in warm versus cold pediatric septic shock. Pediatr Crit Care Med 2020; 21:1051–1058
Srinivasan S, Cornell TT: Bedside ultrasound in pediatric critical care: A review. Pediatr Crit Care Med 2011; 12:667–674
Conlon TW, Nishisaki A, Singh Y, et al.: Moving beyond the stethoscope: Diagnostic point-of-care ultrasound in pediatric practice. Pediatrics 2019; 144:e20191402
Kozyak BW, Yuerek M, Conlon TW: Contemporary use of ultrasonography in acute care pediatrics. Indian J Pediatr 2023; 90:459–469
Su E, Dalesio N, Pustavoitau A: Point-of-care ultrasound in pediatric anesthesiology and critical care medicine. Can J Anaesth 2018; 65:485–498
Leschyna M, Hatam E, Britton S, et al.: Current state of point-of-care ultrasound usage in Canadian emergency departments. Cureus 2019; 11:e4246
Frankel HL, Kirkpatrick AW, Elbarbary M, et al.: Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients—part I: General ultrasonography. Crit Care Med 2015; 43:2479–2502
Levitov A, Frankel HL, Blaivas M, et al.: Guidelines for the appropriate use of bedside general and cardiac ultrasonography in the evaluation of critically ill patients—part II: Cardiac ultrasonography. Crit Care Med 2016; 44:1206–1227
Lee L, DeCara JM: Point-of-care ultrasound. Curr Cardiol Rep 2020; 22:149
Conlon TW, Himebauch AS, Fitzgerald JC, et al.: Implementation of a pediatric critical care focused bedside ultrasound training program in a large academic PICU. Pediatr Crit Care Med 2015; 16:219–226
Conlon TW, Kantor DB, Su ER, et al.: Diagnostic bedside ultrasound program development in pediatric critical care medicine: Results of a national survey. Pediatr Crit Care Med 2018; 19:e561–e568
Singh Y, Tissot C, Fraga MV, et al.: International evidence-based guidelines on point of care ultrasound (POCUS) for critically ill neonates and children issued by the POCUS Working Group of the European Society of Paediatric and Neonatal Intensive Care (ESPNIC). Crit Care 2020; 24:65
Lu JC, Riley A, Conlon T, et al.: Recommendations for cardiac point-of-care ultrasound in children: A report from the American Society of Echocardiography. J Am Soc Echocardiogr 2023; 36:265–277
Conlon TW, Ishizuka M, Himebauch AS, et al.: Hemodynamic bedside ultrasound image quality and interpretation after implementation of a training curriculum for pediatric critical care medicine providers. Pediatr Crit Care Med 2016; 17:598–604
Zeidan A, Liu EL: Practical aspects of point-of-care ultrasound: From billing and coding to documentation and image archiving. Adv Chronic Kidney Dis 2021; 28:270–277
Gold DL, Marin JR, Haritos D, et al.: Pediatric emergency medicine physicians’ use of point-of-care ultrasound and barriers to implementation: A regional pilot study. AEM Educ Train 2017; 1:325–333
Ben Fadel N, Pulgar L, Khurshid F: Point of care ultrasound (POCUS) in Canadian neonatal intensive care units (NICUs): Where are we? J Ultrasound 2019; 22:201–206
Kutty S, Attebery JE, Yeager EM, et al.: Transthoracic echocardiography in pediatric intensive care: Impact on medical and surgical management. Pediatr Crit Care Med 2014; 15:329–335
Harabor A, Soraisham AS: Utility of targeted neonatal echocardiography in the management of neonatal illness. J Ultrasound Med 2015; 34:1259–1263
Papadhima I, Louis D, Purna J, et al.: Targeted neonatal echocardiography (TNE) consult service in a large tertiary perinatal center in Canada. J Perinatol 2018; 38:1039–1045
Jain A, Sahni M, El-Khuffash A, et al.: Use of targeted neonatal echocardiography to prevent postoperative cardiorespiratory instability after patent ductus arteriosus ligation. J Pediatr 2012; 160:584–589.e1
De Martino L, Yousef N, Ben-Ammar R, et al.: Lung ultrasound score predicts surfactant need in extremely preterm neonates. Pediatrics 2018; 142:e20180463
Watkins LA, Dial SP, Koenig SJ, et al.: The utility of point-of-care ultrasound in the pediatric intensive care unit. J Intensive Care Med 2022; 37:1029–1036
EL-Nawawy AA, Abdelmohsen AM, Hassouna HM: Role of echocardiography in reducing shock reversal time in pediatric septic shock: A randomized controlled trial. J Pediatr 2018; 94:31–39
Ranjit S, Aram G, Kissoon N, et al.: Multimodal monitoring for hemodynamic categorization and management of pediatric septic shock: A pilot observational study. Pediatr Crit Care Med 2014; 15:e17–e26
Kaiser R, Sarkar M, Raut S, et al.: A study to compare ultrasound-guided and clinically-guided fluid management in children with septic shock. Indian J Crit Care Med 2023; 27:139–146
Arnoldi S, Glau CL, Walker SB, et al.: Integrating focused cardiac ultrasound into pediatric septic shock assessment. Pediatr Crit Care Med 2021; 22:262–274
Elsayed YN, Amer R, Seshia MM: The impact of integrated evaluation of hemodynamics using targeted neonatal echocardiography with indices of tissue oxygenation: A new approach. J Perinatol 2017; 37:527–535
Ip PYF, Periasamy U, Staffa SJ, et al.: Management changes after echocardiography are associated with improved outcomes in critically ill children. Pediatr Crit Care Med 2024 Apr 9. [online first]
Kaplan SL, Chen AE, Rempell RG, et al.: Impact of emergency medicine point-of-care ultrasound on radiology ultrasound volumes in a single pediatric emergency department. J Am Coll Radiol 2020; 17:1555–1562
Conlon TW, Yousef N, Mayordomo-Colunga J, et al.: Establishing a risk assessment framework for point-of-care ultrasound. Eur J Pediatr 2021; 181:1449–1457
Reaume M, Farishta M, Costello JA, et al.: Analysis of lawsuits related to diagnostic errors from point-of-care ultrasound in internal medicine, paediatrics, family medicine and critical care in the USA. Postgrad Med J 2021; 97:55–58
Nguyen J, Cascione M, Noori S: Analysis of lawsuits related to point-of-care ultrasonography in neonatology and pediatric subspecialties. J Perinatol 2016; 36:784–786
Blaivas M, Pawl R: Analysis of lawsuits filed against emergency physicians for point-of-care emergency ultrasound examination performance and interpretation over a 20-year period. Am J Emerg Med 2012; 30:338–341
Prager R, Wu D, Garber G, et al.: Medico-legal risks of point-of-care ultrasound: A closed-case analysis of Canadian Medical Protective Association medico-legal cases. Ultrasound J 2024; 16:16