Key result
Pediatric emergency physician POCUS achieves ~81% agreement with pediatric cardiologists for measuring interventricular septal thickness.
Why the study?
Hypertrophic cardiomyopathy often goes unidentified in pediatric patients, and the diagnostic accuracy of bedside POCUS by pediatric emergency medicine physicians to measure interventricular septal thickness needed evaluation.
Does point-of-care ultrasound performed by pediatric emergency medicine physicians accurately measure interventricular septal thickness compared to pediatric cardiologists in pediatric patients?
Observational (n=48)
No
Does point-of-care ultrasound performed by pediatric emergency medicine physicians accurately measure interventricular septal thickness compared to pediatric cardiologists in pediatric patients?
Effect estimate: mean error -0.046 (95% CI -0.08 to -0.01)
p-value: p=0.008
Point-of-care ultrasound performed by trained pediatric emergency medicine physicians provides accurate measurements of interventricular septal thickness with excellent agreement to pediatric cardiologists.
Supports PEM POCUS for IVS thickness measurement; leaves open larger validation before routine adoption.
BACKGROUND: Hypertrophic cardiomyopathy is a genetic, life-threatening cardiovascular disease that often goes unidentified in pediatric patients. Patients are often asymptomatic and neither history or physical examination are reliable to detect the disease. The only reliable method to diagnose hypertrophic cardiomyopathy is with echocardiography to look at interventricular septal thickness. Emerging literature has shown that cardiac point-of-care ultrasound (POCUS) performed by pediatric emergency medicine (PEM) physicians is as effective and accurate compared with cardiac echocardiography performed by pediatric cardiologists. OBJECTIVE: The objective of the study was to determine the diagnostic accuracy of POCUS performed by ultrasound-trained PEM physicians in measuring the interventricular septum end diastole (IVSd) thickness in the pediatric emergency department. METHODS: We conducted a prospective, single-center, observational, diagnostic accuracy study to examine the diagnostic accuracy of POCUS in measuring IVSd thickness in pediatric patients who presented to the pediatric emergency department with symptoms that prompted a cardiac POCUS. Cardiac POCUS findings were interpreted by a PEM physician at the bedside and retrospectively by a pediatric cardiologist. Diagnostic concordance of the measurements obtained by the PEM physician and cardiologist was assessed. RESULTS: Forty-eight patients were enrolled. Median patient age was 13.4 years. There was excellent diagnostic agreement on the measurement of the IVSd thickness between PEM physicians and the pediatric cardiologist (81.25% of cases; 39/48). Disagreement was seen in 18.75% of the cases (9/48). The mean error of disagreement was -0.32, with a 95% confidence interval of -0.37 to -0.28. Overall, the mean error of both agreement and disagreement was -0.046, with 95% confidence interval of -0.08 to -0.01 and P value of 0.008. CONCLUSIONS: Point-of-care ultrasound performed by ultrasound-trained PEM physicians to measure pediatric IVSd thickness has a high diagnostic accuracy with excellent agreement with a pediatric cardiologist.
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Hasan et al. (2024) conducted an observational in Hypertrophic cardiomyopathy (n=48). Point-of-care ultrasound (POCUS) by pediatric emergency medicine physicians vs. Interpretation by a pediatric cardiologist was evaluated on Diagnostic agreement on the measurement of the IVSd thickness between PEM physicians and the pediatric cardiologist (mean error -0.046, 95% CI -0.08 to -0.01, p=0.008). Point-of-care ultrasound performed by pediatric emergency medicine physicians showed 81.25% diagnostic agreement with pediatric cardiologists for measuring interventricular septal thickness.
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