Accuracy of Point-Of-Care Cardiac Ultrasound Performed on Patients Admitted to a Pediatric Intensive Care Unit in Shock.

Abstract

Purpose: To assess agreement between a novice pediatric critical care fellow's interpretation of left and right ventricular (LV, RV) function using point-of-care ultrasound (POCUS) compared with assessments by pediatric cardiologists and echocardiography.

Methods: Echocardiographic clips (parasternal long axis, parasternal short axis, and apical four-chamber) and measurements for LV and RV functions (E-point septal separation, ejection fraction, and tricuspid annular plane systolic excursion) were obtained by PICU fellow in patients 0-18 years old with shock. A pediatric cardiologist reviewed the POCUS images. Agreement between the interpretations by the intensivist, cardiologist, and comprehensive echocardiograms were analyzed using Cohen's kappa.

Results: Thirty-one patients were included: 22 had comprehensive echocardiograms. The PICU fellow detected LV dysfunction with 100% sensitivity and > 85% specificity compared with the cardiologist's interpretation and formal echocardiography. Substantial agreement (κ = 0.62) was noted between the intensivist and cardiologist for interpretation of LV function and RV size and pressure (κ = 0.72). The intensivist's assessments showed perfect agreement (κ = 1.0) with echocardiography for LV and RV function. POCUS images ranged from 100% adequate in the parasternal long axis, 90% in the parasternal short axis, and 43% in apical four-chambered views.

Conclusions: A novice PICU fellow could reliably use POCUS to assess the cardiac function in pediatric patients with shock.