Key result
Point-of-care echocardiography by pediatric emergency physicians achieves ~95% sensitivity compared to formal echocardiography.
Why the study?
Pediatric emergency medicine physicians have limited data on the accuracy of point-of-care echocardiography in acutely ill children.
Does point-of-care echocardiography performed by pediatric emergency physicians accurately assess LV function, pericardial effusion, and IVC collapsibility compared to formal echocardiography in acutely ill children?
Observational (n=70)
No
Does point-of-care echocardiography performed by pediatric emergency physicians accurately assess LV function, pericardial effusion, and IVC collapsibility compared to formal echocardiography in acutely ill children?
Point-of-care echocardiography performed by trained pediatric emergency physicians is highly sensitive and specific for assessing LV systolic dysfunction, pericardial effusion, and vascular filling in acutely ill children.
Supports trained pediatric ED physicians performing point-of-care echocardiography; hypothesis-generating and should not yet change practice.
OBJECTIVE: Currently, pediatric emergency medicine (PEM) physicians have limited data on point-of-care echocardiography (POCE). Our goals were to (1) determine the overall accuracy of POCE by PEMs in assessing left ventricular (LV) systolic function visually, presence or absence of pericardial effusion, and cardiac preload by estimating inferior vena cava (IVC) collapsibility, in acutely ill children in the pediatric emergency department; and (2) assess interobserver agreement between the PEM physician and pediatric cardiologist. METHODS: This is a prospective, observational study conducted in an urban, tertiary pediatric facility with an annual census of 67,000 emergency department visits. Patients between the ages of 0 and 18 years meeting 1 or more of the following inclusion criteria were recruited: (1) cardiopulmonary arrest, (2) fluid refractory shock requiring vasoactive infusions, (3) undifferentiated cardiomegaly on chest radiography, and (4) receiving emergent formal echocardiography. All eligible patients underwent POCE by 1 of 2 trained PEM physicians. Dynamic video clips were recorded and reviewed by a pediatric cardiologist who was unaware of the clinical condition of the study patients. RESULTS: For a period of 18 months, we recruited 70 patients. Diminished LV function was noted in 17, pericardial effusion in 16, and abnormal IVC collapsibility in 35 patients. The κ statistics of agreement between the PEM and the cardiologist for detection of LV function, IVC collapsibility, and effusion were 0.87 (95% confidence interval [CI], 0.73-1.00), 0.73 (95% CI, 0.59-0.88), and 0.77 (95% CI, 0.58-0.95), respectively. The overall sensitivity and specificity of POCE compared with a formal echocardiogram was 95% (95% CI, 82%-99%) and 83% (95% CI, 64%-93%), respectively. CONCLUSIONS: With goal-directed training, PEM physicians may be able to perform POCE and accurately assess for significant LV systolic dysfunction, vascular filling, and the presence of pericardial effusion. The model may be expanded to train physicians to use POCE.
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Longjohn et al. (2011) conducted an observational in Acutely ill children (n=70). Point-of-care echocardiography (POCE) vs. Formal echocardiogram was evaluated on Overall sensitivity and specificity of POCE compared with a formal echocardiogram. Point-of-care echocardiography by pediatric emergency physicians showed an overall sensitivity of 95% (95% CI 82-99%) and specificity of 83% (95% CI 64-93%) compared with formal echocardiography.
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