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Moake MM, Klekowski N, Kusulas MP, Kharasch SJ, Teng D, Constantine E. The Current State of Advanced Pediatric Emergency Medicine Point-of-Care Ultrasound (POCUS) Training: Exploring Recent POCUS Fellowship Application Trends and Alternate Training Models. Pediatr Emerg Care 2024; 40:e221-e226. [PMID: 38718425 DOI: 10.1097/pec.0000000000003161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/30/2024]
Abstract
OBJECTIVES This study aims to assess the current state of advanced pediatric emergency medicine (PEM) point-of-care ultrasound (POCUS) training in North America, including trends in dedicated PEM POCUS fellowships and alternative advanced POCUS training pathways, to better guide future educational efforts within the field. METHODS We identified and surveyed 22 PEM POCUS fellowship directors across the United States and Canada regarding PEM POCUS fellowship application trends, potential barriers to pursuing additional POCUS training, and novel training models that meet the needs of the PEM POCUS workforce. RESULTS The past 5 years have seen a growth in both PEM POCUS fellowship program number and trainee positions available, with a general impression by fellowship directors of a high demand for faculty who have these training credentials. However, there was a discordant drop in fellowship applicants and corresponding match rate in 2022, the cause of which is not clear. A number of programs are offering alternative advanced training options including combined PEM/POCUS fellowships and POCUS tracks within PEM fellowship. CONCLUSION As POCUS use within PEM evolves, a growing number of advanced training options are being developed. Understanding the motivations and barriers for pursuing advanced POCUS training can help to shape these options going forward, to ensure the experience incorporated within each model meets the needs of trainees, the needs of PEM divisions, and the future needs of our field.
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Affiliation(s)
- Matthew M Moake
- From the Division of Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, SC
| | - Nicole Klekowski
- Department of Emergency Medicine, University of Michigan, Ann Arbor, MI
| | | | - Sigmund J Kharasch
- Divisions of Pediatric Emergency Medicine and Emergency Medicine Ultrasound, Massachusetts General Hospital, Boston, MA
| | | | - Erika Constantine
- Division of Pediatric Emergency Medicine, Hasbro Children's Hospital/Rhode Island Hospital, Alpert Medical School of Brown University, Providence, RI
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Brant JA, D'Amico B, Orsborn J, Toney AG, Lam SHF, Mickley M, Ambroggio L. Characterizing Point-of-Care Ultrasound Credentialing in Pediatric Emergency Departments. Pediatr Emerg Care 2024; 40:e186-e194. [PMID: 38713835 DOI: 10.1097/pec.0000000000003193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
OBJECTIVE It is unclear which pediatric emergency departments (PEDs) have a point-of-care ultrasound (POCUS) credentialing process or if this process is consistent per expert guidelines. Our objective was to describe formalized POCUS credentialing processes across PEDs that are active in the pediatric emergency medicine POCUS (P2) Network. METHODS A survey was developed from nationally recommended credentialing guidelines. This anonymous survey was sent out to the P2 Network comprising more than 230 members involved in pediatric POCUS. The survey was analyzed using descriptive analysis with counts and percentages. RESULTS A total of 36 PEDs responded to the survey. All departments had a faculty member in charge of maintaining the credentialing process, and all faculty members had POCUS education available; 88.6% of education was scheduled didactics or bedside teaching. There were 80.6% of PEDs that had a process for internally credentialing faculty. Some PEDs offered protected education for POCUS, however, 44.8% had <50% of their faculty credentialed. There were 4 PEDs that offered incentives for completion of POCUS credentialing including salary bonuses; only 1 offered shift buy down as incentive. That PED had 100% of its faculty credentialed. All PEDs performed quality assurance on POCUS scans done in the ED, most done weekly. Billing for scans occurred in 26 PEDs. Skin/soft tissue and focused assessment with sonography for trauma were the 2 most common applications credentialed. CONCLUSIONS Among PEDs surveyed, there was a lack of standardization of POCUS resources and components of credentialing. Incentives may be beneficial in improving credentialing faculty and standardizing the credentialing process.
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Affiliation(s)
- Julia Aogaichi Brant
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Beth D'Amico
- Division of Pediatric Emergency Medicine, Baylor College of Medicine/Texas Children's Hospital, Houston, TX
| | - Jonathan Orsborn
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Amanda G Toney
- Department of Emergency Medicine, Denver Health, Denver, CO
| | - Samuel H F Lam
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
| | - Megan Mickley
- Division of Pediatric Emergency Medicine, ChristianaCare, Newark, DE
| | - Lilliam Ambroggio
- From the Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, Aurora, CO
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Ruthford MR, Shah A, Wolf BJ, Kane ID, Borg K, Moake MM. Ultrasound Investigation of the Fifth Intercostal Space Landmark for Chest Tube Thoracostomy Site Selection in Pediatric Patients. Pediatr Emerg Care 2024; 40:638-643. [PMID: 38713844 PMCID: PMC11365814 DOI: 10.1097/pec.0000000000003207] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/09/2024]
Abstract
OBJECTIVES Chest tube thoracostomy site selection is typically chosen through landmark identification of the fifth intercostal space (ICS). Using point-of-care ultrasound (POCUS), studies have shown this site to be potentially unsafe in many adults; however, no study has evaluated this in children. The primary aim of this study was to evaluate the safety of the fifth ICS for pediatric chest tube placement, with the secondary aim to identify patient factors that correlate with an unsafe fifth ICS. METHODS This was an observational study using POCUS to evaluate the safety of the fifth ICS for chest tube thoracostomy placement using a convenience sample of pediatric emergency department patients. Safety was defined as the absence of the diaphragm appearing within or above the fifth ICS during either tidal or maximal respiration. Univariate and multivariable analyses were used to identify patient factors that correlated with an unsafe fifth ICS. RESULTS Among all patients, 10.3% (95% confidence interval [CI] 6.45-16.1) of diaphragm measurements crossed into or above the fifth ICS during tidal respiration and 27.2% (95% CI 19.0-37.3) during maximal respiration. The diaphragm crossed the fifth ICS more frequently on the right when compared with the left, with an overall rate of 45.0% (95% CI 36.1-54.3) of right diaphragms crossing during maximal respiration. In both univariate and multivariate analyses, a 1-kg/m 2 increase in body mass index was associated with an increase of 10% or more in the odds of crossing during both tidal and maximal respiration ( P = 0.003 or less). CONCLUSIONS A significant number of pediatric patients have diaphragms that cross into or above the fifth ICS, suggesting that placement of a chest tube thoracostomy at this site would pose a significant complication risk. POCUS can quickly and accurately identify these unsafe sites, and we recommend it be used before pediatric chest tube thoracostomy.
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Affiliation(s)
- Mason R Ruthford
- From the Department of Emergency Medicine, University of South Dakota Sanford School of Medicine at Sanford Health, Sioux Falls, SD
| | | | | | - Ian D Kane
- Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, SC
| | | | - Matthew M Moake
- Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, SC
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Şık N, Arslan G, Akca Çağlar A, Ülgen Tekerek N, Fidancı İ, Tolu Kendir Ö, Bal A, Özgür Horoz Ö, Anıl AB, Yıldızdaş D, Duman M, Dursun O. The Use of Point-of-Care Ultrasound in Pediatric Emergency Departments and Intensive Care Units: A Descriptive Study From Turkey. Pediatr Emerg Care 2024:00006565-990000000-00505. [PMID: 39178376 DOI: 10.1097/pec.0000000000003252] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/25/2024]
Abstract
OBJECTIVES The aim was to evaluate the current status of point-of-care ultrasound (POCUS), perceptions, education, training, and barriers to using POCUS in pediatric emergency departments (PEDs) and pediatric intensive care units (PICUs) in Turkey. METHODS A descriptive, multicenter, cross-sectional study through an online survey was developed using the REDCap online platform. The survey was distributed through the Turkish Society of Pediatric Emergency and Intensive Care e-mail group. Each survey was answered only once by each PED/PICU and by the clinical chief of the department. RESULTS A total of 19 PEDs and 26 PICUs responded to the survey. Among them, 84.2% of PEDs and 100% of PICUs reported the clinical use of POCUS. For diagnostic applications, the most common areas for PEDs and PICUs were thoracic (93.7%/100%) and cardiovascular (62.5%/65.4%) assessment, and in the procedural use of POCUS, the most frequent applications were those for vascular access (75.0%/92.3%) and thoracentesis (31.2%/65.4%). The most commonly reported clinical benefits were rapid diagnosis, rapid treatment, and decreased complications during procedural applications for PEDs and PICUs. Evaluating the barriers to POCUS use in PEDs and PICUs, the most common reasons for insufficient use were the lack of ultrasound machines and/or equipment, a shortage of manpower, lack of awareness, and lack of training. For PEDs (68.4%) and for PICUs (84.6%), participants agreed that POCUS training should be mandatory during fellowship programs. CONCLUSIONS Most participants were aware of the need for POCUS. However, lack of education, equipment, manpower, and infrastructure still emerged as barriers to the use of POCUS. To further promote POCUS use, it would be helpful to improve accessibility by ensuring sufficient numbers of ultrasound devices together with sufficient numbers of appointed physicians and by expanding POCUS education in PEDs and PICUs.
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Affiliation(s)
- Nihan Şık
- From the Pediatric Emergency Department, Balikesir Ataturk City Hospital, Balikesir, Turkey
| | - Gazi Arslan
- Pediatric Intensive Care Unit, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Ayla Akca Çağlar
- Pediatric Emergency Department, Gazi University Faculty of Medicine, Ankara, Turkey
| | - Nazan Ülgen Tekerek
- Pediatric Intensive Care Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - İlknur Fidancı
- Pediatric Emergency Department, Ankara Research and Training Hospital, Ankara, Turkey
| | - Özlem Tolu Kendir
- Pediatric Emergency Department, Akdeniz University Faculty of Medicine, Antalya, Turkey
| | - Alkan Bal
- Pediatric Emergency Department, Manisa Celal Bayar University Faculty of Medicine, Hafsa Sultan Hospital, Manisa, Turkey
| | - Özden Özgür Horoz
- Pediatric Intensive Care Unit, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Ayşe Berna Anıl
- Pediatric Intensive Care Unit, Izmir Katip Celebi Faculty of Medicine, Izmir, Turkey
| | - Dinçer Yıldızdaş
- Pediatric Intensive Care Unit, Cukurova University Faculty of Medicine, Adana, Turkey
| | - Murat Duman
- Pediatric Emergency Department, Dokuz Eylul University Faculty of Medicine, Izmir, Turkey
| | - Oğuz Dursun
- Pediatric Intensive Care Unit, Akdeniz University Faculty of Medicine, Antalya, Turkey
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Kharasch SJ, Moake M, Riera A. Pediatric Emergency Medicine Ultrasound Fellowship Programs. POCUS JOURNAL 2024; 9:5-8. [PMID: 38681171 PMCID: PMC11044938 DOI: 10.24908/pocus.v9i1.17372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/01/2024]
Abstract
Point of care ultrasound (POCUS) has undergone important growth in the field of Pediatric Emergency Medicine (PEM) in the last 14 years and is recognized as a critical diagnostic tool in the care of ill and injured children. The first PEM POCUS fellowship was established in 2010. Now, there are currently 30 ultrasound fellowships that offer training to PEM physicians. In 2014, 46 PEM POCUS leaders established the P2 (PEM POCUS) Network (www.P2network.org). This serves as a platform for sharing expertise, building research collaborations, and offering mentorship in the use of POCUS in PEM. In 2019, a multinational group of experts in PEM POCUS published the first consensus guidelines for prioritizing core applications of POCUS, which are fundamental to PEM fellowship training 1. In 2022, the international research priorities for PEM POCUS were published 2. In the same year, the development of a consensus-based definition of focused assessment with sonography for trauma (FAST) in children was established 3.
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Affiliation(s)
- Sigmund J. Kharasch
- Massachusetts General HospitalBoston, MAUSA
- Harvard Medical SchoolBoston, MAUSA
| | - Matthew Moake
- Yale-New Haven Children's HospitalNew Haven, CTUSA
- Yale School of MedicineNew Haven, CTUSA
| | - Antonio Riera
- Medical University of South CarolinaCharleston, SCUSA
- Shawn Jenkins Children's HospitalCharleston, NCUSA
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6
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Cheon EJ, Yoon JM. Reliability of renal point-of-care ultrasound (POCUS) performed by pediatric postgraduates to diagnose hydronephrosis in infants. Front Pediatr 2024; 12:1361223. [PMID: 38655276 PMCID: PMC11035807 DOI: 10.3389/fped.2024.1361223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/25/2023] [Accepted: 03/25/2024] [Indexed: 04/26/2024] Open
Abstract
Purpose Point-of-care ultrasound (POCUS) has gained prominence in a variety of medical specialties due to advances in ultrasound technology. POCUS has not been fully integrated into pediatric residency training programs despite its widespread use and proven benefits. At our institution, renal POCUS is performed by pediatric residents for the evaluation of hydronephrosis, which is the main pathology for which ultrasound is used in the clinical practice of pediatric nephrology. This study was conducted to evaluate the quality of renal POCUS performed by pediatric residents in infants. Methods Four pediatric residents, comprising two first-year and two second-year residents at Konyang University Hospital, participated in the study conducted from May 2021 to May 2022. All participants had completed our Point-of-Care Ultrasound (POCUS) training program. The study focused on infants admitted to the pediatric inpatient unit, identified by attending physicians as requiring renal ultrasound. All infants underwent their initial kidney ultrasound examination. Temporal alignment between renal Point-of-Care Ultrasound (POCUS) performed by pediatric residents and conventional ultrasound (USG) conducted by radiologists was asynchronous. Pediatric residents conducted POCUS sessions during scheduled radiologist appointments throughout the day, occurring either before or after the radiologist's examination. There was no mutual awareness of each other's results. Inter-observer agreement between radiologists and pediatric residents was compared for the presence or absence of hydronephrosis and its grade, which are primary considerations in pediatric renal ultrasound. Results Our study found that 53 infants (68.8%) were diagnosed with hydronephrosis using point-of-care ultrasound (POCUS), compared to 48 infants (62.3%) diagnosed with conventional ultrasound (USG). Among the POCUS examinations conducted by pediatric residents, hydronephrosis of SFU grades 1, 2, 3, and 4 were observed in 56.6%, 35.8%, 7.5%, and 0%, respectively. Inter-observer reliability between POCUS and conventional USG showed good agreement, with Cohen's kappa coefficients exceeding 0.8 for sensitivity and 0.6 for grading. Conclusions Renal POCUS performed well in diagnosing and grading hydronephrosis in infants when performed by pediatric residents who had completed a two-phase training program.
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Affiliation(s)
- Eun Jung Cheon
- Department of Pediatrics, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jung Min Yoon
- Department of Pediatrics, Konyang University Hospital, Daejeon, Republic of Korea
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McNamara PJ, Jain A, El-Khuffash A, Giesinger R, Weisz D, Freud L, Levy PT, Bhombal S, de Boode W, Leone T, Richards B, Singh Y, Acevedo JM, Simpson J, Noori S, Lai WW. Guidelines and Recommendations for Targeted Neonatal Echocardiography and Cardiac Point-of-Care Ultrasound in the Neonatal Intensive Care Unit: An Update from the American Society of Echocardiography. J Am Soc Echocardiogr 2024; 37:171-215. [PMID: 38309835 DOI: 10.1016/j.echo.2023.11.016] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2024]
Abstract
Targeted neonatal echocardiography (TNE) involves the use of comprehensive echocardiography to appraise cardiovascular physiology and neonatal hemodynamics to enhance diagnostic and therapeutic precision in the neonatal intensive care unit. Since the last publication of guidelines for TNE in 2011, the field has matured through the development of formalized neonatal hemodynamics fellowships, clinical programs, and the expansion of scientific knowledge to further enhance clinical care. The most common indications for TNE include adjudication of hemodynamic significance of a patent ductus arteriosus, evaluation of acute and chronic pulmonary hypertension, evaluation of right and left ventricular systolic and/or diastolic function, and screening for pericardial effusions and/or malpositioned central catheters. Neonatal cardiac point-of-care ultrasound (cPOCUS) is a limited cardiovascular evaluation which may include line tip evaluation, identification of pericardial effusion and differentiation of hypovolemia from severe impairment in myocardial contractility in the hemodynamically unstable neonate. This document is the product of an American Society of Echocardiography task force composed of representatives from neonatology-hemodynamics, pediatric cardiology, pediatric cardiac sonography, and neonatology-cPOCUS. This document provides (1) guidance on the purpose and rationale for both TNE and cPOCUS, (2) an overview of the components of a standard TNE and cPOCUS evaluation, (3) disease and/or clinical scenario-based indications for TNE, (4) training and competency-based evaluative requirements for both TNE and cPOCUS, and (5) components of quality assurance. The writing group would like to acknowledge the contributions of Dr. Regan Giesinger who sadly passed during the final revisions phase of these guidelines. Her contributions to the field of neonatal hemodynamics were immense.
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Affiliation(s)
| | - Amish Jain
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Afif El-Khuffash
- Department of Paediatrics, Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Regan Giesinger
- Department of Pediatrics, University of Iowa, Iowa City, Iowa
| | - Dany Weisz
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Lindsey Freud
- Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Philip T Levy
- Division of Newborn Medicine, Boston Children's Hospital, and Department of Pediatrics, Harvard Medical School, Boston, Massachusetts
| | - Shazia Bhombal
- Department of Pediatrics, Division of Neonatology, Emory University and Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Willem de Boode
- Department of Neonatology, Radboud University Medical Center, Radboud Institute for Health Sciences, Amalia Children's Hospital, Nijmegen, the Netherlands
| | - Tina Leone
- Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | | | - Yogen Singh
- Loma Linda University School of Medicine, Loma Linda, California
| | - Jennifer M Acevedo
- Department of Pediatrics-Cardiology, Ann and Robert H. Lurie Children's Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - John Simpson
- Department of Pediatrics, Evelina London Children's Hospital, London, United Kingdom
| | - Shahab Noori
- Fetal and Neonatal Institute, Division of Neonatology, Children's Hospital Los Angeles, Department of Pediatrics, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Wyman W Lai
- CHOC Children's Hospital, Orange, California; University of California, Irvine, Orange, California
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Flores S, Su E, Moher JM, Adler AC, Riley AF. Point-of-Care-Ultrasound in Pediatrics: A Review and Update. Semin Ultrasound CT MR 2024; 45:3-10. [PMID: 38056790 DOI: 10.1053/j.sult.2023.12.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/08/2023]
Abstract
Point-of-Care-Ultrasound (POCUS) has encountered a tremendous expansion in patient care. POCUS has taken a central role during invasive procedures. POCUS has expanded to most subspecialties from adult to pediatric and neonatal health care. POCUS in pediatrics has also become part of specific critical situations such as myocardial function assessment during cardiac arrest, extracorporeal membrane oxygenation deployment and neurological evaluation. In this review we will go over the most important historical aspects of POCUS. We will also review important aspects of POCUS in the intensive care unit, cardiologist evaluation and in the emergency department among others.
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Affiliation(s)
- Saul Flores
- Department of Pediatrics, Division of Critical Care and Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX.
| | - Erik Su
- Department of Pediatrics, Division of Critical Care, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Justin M Moher
- Department of Pediatrics, Division of Emergency Medicine, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Adam C Adler
- Department of Anesthesiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
| | - Alan F Riley
- Department of Pediatrics, Division of Cardiology, Texas Children's Hospital and Baylor College of Medicine, Houston, TX
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Ali N, Shakeel E, Soomar SM. Need of Point of Care Ultrasound Training in Pediatric Emergency Medicine Practice: A Wake-Up Call for the Low-Income Countries. Glob Pediatr Health 2023; 10:2333794X231187485. [PMID: 37484605 PMCID: PMC10357049 DOI: 10.1177/2333794x231187485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/22/2023] [Accepted: 06/26/2023] [Indexed: 07/25/2023] Open
Abstract
POCUS is the acquisition, interpretation, and rapid clinical integration of ultrasonographic imaging performed by the treating physician at the patient's bedside. It is used in the field Emergency Medicine to assist in diagnosing and managing various clinical conditions ranging from undifferentiated shock, respiratory failure, and cardiac arrest, which have shown a positive impact on clinical decision-making, resulting in a decreased emergency department and hospital length of stay. POCUS is also a valuable diagnostic tool in managing pediatric patients for whom radiation exposure is a significant concern. It is used to aid in diagnosing and managing various pediatric medical and surgical emergencies. Despite the evident literature regarding the utility of POCUS in Pediatric Emergency Medicine (PEM) practice, there is a lack of specialized training for pediatric emergency physicians, especially in low-income countries. Therefore, this comment emphasizes the need for POCUS training in PEM.
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Affiliation(s)
- Noman Ali
- Aga Khan University, Karachi, Pakistan
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10
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Lu JC, Riley A, Conlon T, Levine JC, Kwan C, Miller-Hance WC, Soni-Patel N, Slesnick T. 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. [PMID: 36697294 DOI: 10.1016/j.echo.2022.11.010] [Citation(s) in RCA: 13] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Cardiac point-of-care ultrasound has the potential to improve patient care, but its application to children requires consideration of anatomic and physiologic differences from adult populations, and corresponding technical aspects of performance. This document is the product of an American Society of Echocardiography task force composed of representatives from pediatric cardiology, pediatric critical care medicine, pediatric emergency medicine, pediatric anesthesiology, and others, assembled to provide expert guidance. This diverse group aimed to identify common considerations across disciplines to guide evolution of indications, and to identify common requirements and infrastructure necessary for optimal performance, training, and quality assurance in the practice of cardiac point-of-care ultrasound in children. The recommendations presented are intended to facilitate collaboration among subspecialties and with pediatric echocardiography laboratories by identifying key considerations regarding (1) indications, (2) imaging recommendations, (3) training and competency assessment, and (4) quality assurance.
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Affiliation(s)
- Jimmy C Lu
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan
| | - Alan Riley
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Thomas Conlon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jami C Levine
- Harvard School of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | - Charisse Kwan
- University of Western Ontario, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | | | | | - Timothy Slesnick
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
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11
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Heffler MA, Brant JA, Singh A, Toney AG, Harel-Sterling M, Grandjean-Blanchet C, Riera A, Khalil PA, Starr-Seal RL, Binder ZW. Ultrasound-Guided Regional Anesthesia of the Femoral Nerve in the Pediatric Emergency Department. Pediatr Emerg Care 2023; 39:e30-e34. [PMID: 35245015 DOI: 10.1097/pec.0000000000002607] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES Femur fractures are painful, and use of systemic opioids and other sedatives can be dangerous in pediatric patients. The fascia iliaca compartment nerve block and femoral nerve block are regional anesthesia techniques to provide analgesia by anesthetizing the femoral nerve. They are widely used in adult patients and are associated with good effect and reduced opioid use. Ultrasound (US) guidance of nerve blocks can increase their safety and efficacy. We sought to report on the use and safety of US-guided regional anesthesia of the femoral nerve performed by emergency physicians for femur fractures in 6 pediatric emergency departments. METHODS Records were queried at 6 pediatric EDs across North America to identify patients with femur fractures managed with US-guided regional anesthesia of the femoral nerve between January 1, 2016, and May 1, 2021. Data were abstracted regarding demographics, injury pattern, nerve block technique, and analgesic use before and after nerve block. RESULTS Eighty-five cases were identified. Median age was 5 years (interquartile range, 2-9 years). Most patients were male and had sustained blunt trauma (59% low-mechanism falls). Ninety-four percent of injuries were managed operatively. Most patients (79%) received intravenous opioid analgesia before their nerve block. Ropivacaine was the most common local anesthetic used (69% of blocks). No procedural complications or adverse effects were identified. CONCLUSIONS Ultrasound-guided regional anesthesia of the femoral nerve is widely performed and can be performed safely on pediatric patients by emergency physicians and trainees in the pediatric emergency department.
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Affiliation(s)
- Michael A Heffler
- From the Denver Health Residency in Emergency Medicine, Denver Health Medical Center, Denver
| | - Julia A Brant
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Children's Hospital Colorado, University of Colorado, Aurora, CO
| | - Amar Singh
- Division of Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, KY
| | - Amanda G Toney
- Department of Emergency Medicine, Denver Health Medical Center, University of Colorado, Aurora, CO
| | - Maya Harel-Sterling
- Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Charlotte Grandjean-Blanchet
- Division of Emergency Medicine, Department of Pediatrics, Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Antonio Riera
- Section of Pediatric Emergency Medicine, Department of Pediatrics, Yale University, New Haven, CT
| | - Paul A Khalil
- Division of Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, KY
| | - Rebecca L Starr-Seal
- Division of Emergency Medicine, Department of Pediatrics, University of Louisville, Louisville, KY
| | - Zachary W Binder
- Division of Emergency Medicine, Department of Pediatrics, University of Massachusetts Memorial Medical Center, University of Massachusetts, Worchester, MA
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12
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Nti BK, Kennedy S, Sarmiento E, Weinstein E, Russell F. Pediatric Emergency Medicine Faculty Response to Point-of-Care Ultrasound Credentialing Curriculum. Pediatr Emerg Care 2023; 39:e35-e40. [PMID: 36099540 DOI: 10.1097/pec.0000000000002843] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES As point-of-care ultrasound (POCUS) continues to evolve in pediatric emergency medicine (PEM), new protocols and curricula are being developed to help establish the standards of practice and delineate training requirements. New suggested guidelines continue to improve, but a national standard curriculum for training and credentialing PEM providers is still lacking. To understand the barriers and perception of curriculum implementation for PEM providers, we created an ultrasound program at our institution and observed attitudes and response to training. METHODS Fourteen PEM-fellowship-trained faculty with limited to no previous experience with POCUS underwent training within a 12-month time frame using a modified practice-based training that included didactics, knowledge assessment, and hands-on practice. As part of the curriculum, the faculty completed a 3-phase survey before, after, and 6 months after completion of the curriculum. RESULTS There was a 100%, 78.6%, and 71.4% response rate for the presurvey, postsurvey, and 6 months postsurvey, respectively. Lack of confidence with using POCUS went from 100% on the presurvey to 57% on the postsurvey and down to 30% on the 6th month postsurvey. All other barriers also decreased from precurriculum to postcurriculum, except for length of time to perform POCUS. Participants rated the curriculum highly, with a mean Likert score and standard error of the mean at 3.9 ± 0.73, respectively. The average rating for whether POCUS changed clinical practice was low (2.6 ± 1.34). CONCLUSION These results show that a simplified structured curriculum can improve perception of POCUS and decrease barriers to usage while helping to understand obstacles for implementation of POCUS among PEM-fellowship-trained faculty.
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Affiliation(s)
| | - Sarah Kennedy
- Division of Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | - Elizabeth Weinstein
- From the Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Frances Russell
- Division of Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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13
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Lawson SL, Breslin KA, Thomas-Mohtat R, Abo AM, Cohen JS. Factors Associated With Point-of-Care Ultrasound Use by Recent Pediatric Emergency Medicine Fellowship Graduates. Pediatr Emerg Care 2023; 39:33-39. [PMID: 36580890 DOI: 10.1097/pec.0000000000002606] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE The aims of this study were to describe point-of-care ultrasound (POCUS) use by recent pediatric emergency medicine (PEM) fellowship graduates and identify associations between frequency and breadth of POCUS use with variations in POCUS training and current clinical practice environment. METHODS This was a cross-sectional online survey of recent PEM fellowship graduates. Chi-square and nonparametric tests were used to compare POCUS use among physicians with varying types of POCUS training and varying clinical practice environments. RESULTS Eighty-two percent of 143 respondents reported using POCUS in their past 10 shifts. There was no association between the methods of POCUS education and frequency or breadth of POCUS use. Pediatric emergency medicine fellowship graduates with additional POCUS fellowship training performed more scans and used more applications than those who completed a pediatrics or medicine-pediatrics residency before PEM fellowship only [median 15 (9, 20) vs 2 (1, 5) (P < 0.01) and median 11 (6.5, 13) vs 2 (1, 3) (P < 0.01), respectively]. Participants who worked in academic emergency departments performed more ultrasounds than those who did not [3.5 (1, 8) vs 1 (0, 2), P < 0.01] and used a greater breadth of applications [3 (1, 5) vs 1 (0, 3), P < 0.01]. Physicians who billed for POCUS studies were more likely to use POCUS (odds ratio, 2.8; 95% confidence interval, 1.1-7.3) with greater frequency [5 (2.3, 10) vs 2 (0.8, 5), P < 0.01] and use a broader range of applications [3 (2,6) vs 2 (0.8, 3.3), P < 0.01]. CONCLUSION Most respondents report recent POCUS use in practice. Point-of-care ultrasound fellowship training, working in an academic emergency department, and having the ability to bill were associated with increased POCUS use.
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Affiliation(s)
- Simone L Lawson
- From the Children's National Hospital, Division of Emergency Medicine and Trauma Services, The George Washington University School of Medicine and Health Sciences, Washington, DC
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14
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Škulec R. Point‑of‑Care Ultrasound - accuracy, education. VNITRNI LEKARSTVI 2023; 69:223-228. [PMID: 37468288 DOI: 10.36290/vnl.2023.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/21/2023]
Abstract
A review article discussing the reliability of Point-of-Care ultrasound and education in this method in various fields of medicine.
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15
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Snelling PJ, Shefrin AE, Moake MM, Bergmann KR, Constantine E, Deanehan JK, Dessie AS, Elkhunovich MA, Gold DL, Kornblith AE, Lin‐Martore M, Nti B, Pade KH, Parri N, Sivitz A, Lam SHF. Establishing the international research priorities for pediatric emergency medicine point-of-care ultrasound: A modified Delphi study. Acad Emerg Med 2022; 29:1338-1346. [PMID: 36043227 PMCID: PMC9826219 DOI: 10.1111/acem.14588] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2022] [Revised: 08/23/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND The Pediatric Emergency Medicine (PEM) Point-of-care Ultrasound (POCUS) Network (P2Network) was established in 2014 to provide a platform for international collaboration among experts, including multicenter research. The objective of this study was to use expert consensus to identify and prioritize PEM POCUS topics, to inform future collaborative multicenter research. METHODS Online surveys were administered in a two-stage, modified Delphi study. A steering committee of 16 PEM POCUS experts was identified within the P2Network, with representation from the United States, Canada, Italy, and Australia. We solicited the participation of international PEM POCUS experts through professional society mailing lists, research networks, social media, and "word of mouth." After each round, responses were refined by the steering committee before being reissued to participants to determine the ranking of all the research questions based on means and to identify the high-level consensus topics. The final stage was a modified Hanlon process of prioritization round (HPP), which emphasized relevance, impact, and feasibility. RESULTS Fifty-four eligible participants (16.6%) provided 191 items to Survey 1 (Round 1). These were refined and consolidated into 52 research questions by the steering committee. These were issued for rating in Survey 2 (Round 2), which had 45 participants. At the completion of Round 2, all questions were ranked with six research questions reaching high-level consensus. Thirty-one research questions with mean ratings above neutral were selected for the HPP round. Highly ranked topics included clinical applications of POCUS to evaluate and manage children with shock, cardiac arrest, thoracoabdominal trauma, suspected cardiac failure, atraumatic limp, and intussusception. CONCLUSIONS This consensus study has established a research agenda to inform future international multicenter PEM POCUS trials. This study has highlighted the ongoing need for high-quality evidence for PEM POCUS applications to guide clinical practice.
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Affiliation(s)
- Peter J. Snelling
- Department of Emergency MedicineGold Coast University Hospital and Griffith UniversitySouthportQueenslandAustralia
| | - Allan E. Shefrin
- Department of PediatricsChildren's Hospital of Eastern OntarioOttawaOntarioCanada
| | - Matthew M. Moake
- Department of Pediatric Emergency MedicineMedical University of South CarolinaCharlestonSouth CarolinaUSA
| | - Kelly R. Bergmann
- Department of Pediatric Emergency MedicineChildren's MinnesotaMinneapolisMinnesotaUSA
| | - Erika Constantine
- Division of Pediatric Emergency MedicineHasbro Children's Hospital/Rhode Island Hospital and Brown UniversityProvidenceRhode IslandUSA
| | - J. Kate Deanehan
- Division of Pediatric Emergency MedicineJohns Hopkins Children's Center BaltimoreBaltimoreMarylandUSA
| | - Almaz S. Dessie
- Department of Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNew YorkUSA
| | - Marsha A. Elkhunovich
- Division of Emergency and Transport MedicineChildren's Hospital Los AngelesLos AngelesCaliforniaUSA
| | - Delia L. Gold
- Division of Emergency MedicineNationwide Children's Hospital and Ohio State UniversityColumbusOhioUSA
| | - Aaron E. Kornblith
- Department of Emergency MedicineUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Margaret Lin‐Martore
- Department of PediatricsUniversity of California San FranciscoSan FranciscoCaliforniaUSA
| | - Benjamin Nti
- Riley Hospital for Children at Indiana University HealthIndianapolisIndianaUSA
| | - Kathryn H. Pade
- Division of Pediatric Emergency MedicineRady Children's Hospital San Diego and University of California at San DiegoSan DiegoCaliforniaUSA
| | - Niccolò Parri
- Department of Emergency MedicineMeyer University Children's HospitalFlorenceItaly
| | - Adam Sivitz
- Children's Hospital of New JerseyNewark Beth Israel Medical CenterNewarkNew JerseyUSA
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16
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Hulse WN, Bell CR, Roosevelt GE, Sabbadini L, Germano R, Hopkins E, Kendall J, Toney AG. Evaluation of a Novel Point-of-Care Ultrasound Curriculum for First-Year Pediatric Residents. Pediatr Emerg Care 2022; 38:605-608. [PMID: 36314862 DOI: 10.1097/pec.0000000000002853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE The aim of the study is to evaluate a novel point-of-care ultrasound (POCUS) educational curriculum for pediatric residents. METHODS The cohort study in graduate medical education was completed from January 2017 to March 2019. Postgraduate year 1 (PGY1) pediatric residents attended the educational curriculum that consisted of 3 half-day sessions over a 3-month period. Each session consisted of a lecture (introduction, extended focused assessment with sonography for trauma, soft tissue/musculoskeletal, cardiac, and resuscitative applications) followed by supervised hands-on scanning sessions. Group ratio was 3 learners to 1 machine/expert instructor. Main outcome measures included pre- and post-written test scores, as well as objective structured clinical examination (OSCE) scores. RESULTS Forty-nine PGY1 residents (78% women) completed the curriculum. The mean (SD) pretest score was 68% (8.5), and the mean posttest score was 83% (8.3) with a difference of 15 (95% confidence interval, 12.5-17.6; P < 0.001). Mean (SD) focused assessment with sonography for trauma OSCE score after the curriculum was 88.7% (11.9). The number of PGY1 pediatric residents that were comfortable performing POCUS examinations increased from pretraining to posttraining for soft tissue/musculoskeletal (14%-61%, P < 0.001), extended focused assessment with sonography for trauma (24%-90%, P < 0.001), and cardiac (18%-86%, P < 0.001). All participants found the curriculum useful, and 42 of 49 (86%) stated the curriculum increased their ability to acquire and interpret images. CONCLUSIONS Postgraduate year 1 pediatric residents learned the basics of POCUS through 3 brief educational sessions. The increase in posttest scores demonstrated improved POCUS knowledge, and the high OSCE score demonstrated their ability to acquire ultrasound images. Point-of-care ultrasound guidelines are needed for pediatric residency programs.
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Affiliation(s)
- Whitley N Hulse
- From the Division of Neonatology, Department of Pediatrics, University of Utah Health, Salt Lake City, UT
| | - Colin R Bell
- Department of Emergency Medicine, Queen's University, Kingston, Canada
| | - Genie E Roosevelt
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, CO
| | - Linda Sabbadini
- Università degli Studi di Brescia, Facoltà di Medicina e Chirurgia, Spedali Civili di Brescia, Brescia, Italy
| | - Rocco Germano
- Università degli Studi di Brescia, Facoltà di Medicina e Chirurgia, Spedali Civili di Brescia, Brescia, Italy
| | - Emily Hopkins
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, CO
| | - John Kendall
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, CO
| | - Amanda G Toney
- Department of Emergency Medicine, University of Colorado School of Medicine, Denver Health Medical Center, Denver, CO
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17
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Shah A, Moake MM. Diagnosis of Internal Jugular Vein Septic Thrombophlebitis by Point-of-Care Ultrasound. Pediatr Emerg Care 2022; 38:568-571. [PMID: 35477931 DOI: 10.1097/pec.0000000000002726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Septic thrombophlebitis represents a rare but serious collection of diseases, which carry a high risk of morbidity and mortality requiring prompt and aggressive treatment. Diagnosis centers on identification of thrombus along with clinical and microbiologic data. We present a case where point-of-care ultrasound was used to diagnose septic thrombophlebitis of the internal jugular vein and expedite appropriate therapy. We further review the technique and literature for ultrasound diagnosis of venous thrombosis and associated thrombophlebitis.
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Affiliation(s)
- Aalap Shah
- From the Departments of Emergency Medicine
| | - Matthew M Moake
- Pediatric Emergency Medicine, Medical University of South Carolina, Charleston, SC
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18
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Bergmann KR, Khant M, Lammers S, Arroyo AC, Avendano P, Chaudoin L, Cohen SG, Deanehan JK, Kornblith AE, Lam SHF, Lin-Martore M, Malia L, Pade KH, Park DB, Sivitz A, Shahar-Nissan K, Snelling PJ, Tessaro MO, Thomas-Mohtat R, Whitcomb V, Yock-Corrales A, Walsh P, Watson D, Madhok M. Accuracy and Interrater Reliability of Point-of-Care Ultrasonography Image Interpretation for Intussusception. Pediatr Emerg Care 2022; 38:442-447. [PMID: 36040465 DOI: 10.1097/pec.0000000000002786] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVES The aim of this study was to determine the accuracy and interrater reliability of (1) point-of-care ultrasound (POCUS) image interpretation for identification of intussusception and (2) reliability of secondary signs associated with intussusception among experts compared with novice POCUS reviewers. METHODS We conducted a planned secondary analysis of a prospective, convenience sample of children aged 3 months to 6 years who were evaluated with POCUS for intussusception across 17 international pediatric emergency departments between October 2018 and December 2020. A random sample of 100 POCUS examinations was reviewed by novice and expert POCUS reviewers. The primary outcome was identification of the presence or absence of intussusception. Secondary outcomes included intussusception size and the presence of trapped free fluid or echogenic foci. Accuracy was summarized using sensitivity and specificity, which were estimated via generalized mixed effects logistic regression. Interrater reliability was summarized via Light's κ statistics with bootstrapped standard errors (SEs). Accuracy and reliability of expert and novice POCUS reviewers were compared. RESULTS Eighteen expert and 16 novice POCUS reviewers completed the reviews. The average expert sensitivity was 94.5% (95% confidence interval [CI], 88.6-97.5), and the specificity was 94.3% (95% CI, 90.3-96.7), significantly higher than the average novice sensitivity of 84.7% (95% CI, 74.3-91.4) and specificity of 80.4% (95% CI, 72.4, 86.7). κ was significantly greater for expert (0.679, SE 0.039) compared with novice POCUS reviewers (0.424, SE 0.044; difference 0.256, SE 0.033). For our secondary outcome measure of intussusception size, κ was significantly greater for experts (0.661, SE 0.038) compared with novices (0.397, SE 0.041; difference 0.264, SE 0.029). Interrater reliability was weak for expert and minimal for novice reviewers regarding the detection of trapped free fluid and echogenic foci. CONCLUSIONS Expert POCUS reviewers demonstrate high accuracy and moderate interrater reliability when identifying intussusception via image interpretation and perform better than novice reviewers.
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Affiliation(s)
- Kelly R Bergmann
- From the Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Marshal Khant
- From the Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Shea Lammers
- From the Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Alexander C Arroyo
- Department of Emergency Medicine, Maimonides Medical Center, Brooklyn, NY
| | - Pablo Avendano
- Division of Pediatric Emergency Medicine, University of Minnesota Masonic Children's Hospital, Minneapolis, MN
| | - Lindsey Chaudoin
- Department of Emergency Medicine, Atrium Health's Carolinas Medical Center, Charlotte, NC
| | - Stephanie G Cohen
- Department of Pediatrics and Emergency Medicine, Children's Healthcare Atlanta and Emory University, Atlanta, GA
| | - J Kate Deanehan
- Department of Pediatric Emergency Medicine, Johns Hopkins Children's Center, Baltimore, MD
| | - Aaron E Kornblith
- Departments of Emergency Medicine and Pediatrics, University of California, San Francisco, San Francisco
| | - Samuel H F Lam
- Department of Emergency Medicine, Sutter Medical Center Sacramento, Sacramento, CA
| | - Margaret Lin-Martore
- Departments of Emergency Medicine and Pediatrics, University of California, San Francisco, San Francisco
| | - Laurie Malia
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY
| | - Kathryn H Pade
- Department of Pediatrics, University of California, San Diego, CA
| | - Daniel B Park
- Department of Pediatrics and Emergency Medicine, University of North Carolina, Chapel Hill, NC
| | - Adam Sivitz
- Department of Emergency Medicine, Newark Beth Israel Medical Center, Newark, NJ
| | - Keren Shahar-Nissan
- Department of Emergency Medicine, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Peter J Snelling
- Department of Pediatric Emergency Medicine, Gold Coast University Hospital and Griffith University, Southport, Queensland, Australia
| | - Mark O Tessaro
- Division of Pediatric Emergency Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Rosemary Thomas-Mohtat
- Department of Pediatric Emergency Medicine, Children's National Hospital, Washington, DC
| | - Valerie Whitcomb
- From the Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN
| | - Adriana Yock-Corrales
- Department of Emergency Medicine, Hospital Nacional de Niños "Dr. Carlos Sáenz Herrera," CCSS, San José, Costa Rica
| | - Paige Walsh
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Dave Watson
- Department of Research and Sponsored Programs, Children's Minnesota, Minneapolis, MN
| | - Manu Madhok
- From the Department of Emergency Medicine, Children's Minnesota, Minneapolis, MN
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19
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Arichai P, Delaney M, Slamowitz A, Rosario R, Gordish-Dressman H, Basu S, Kern J, Maxwell A, Abo A. Pediatric Residency Point-of-Care Ultrasound Training Needs Assessment and Educational Intervention. Cureus 2022; 14:e28696. [PMID: 36204025 PMCID: PMC9527041 DOI: 10.7759/cureus.28696] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2022] [Indexed: 11/06/2022] Open
Abstract
Background Prior studies showed that point-of-care ultrasound (POCUS) training is not commonly offered in pediatric residency. We assessed the need for a pediatric POCUS curriculum by evaluating pediatric trainees' attitudes toward the use of POCUS and identifying barriers to training. We also aimed to evaluate the impact of a POCUS educational intervention on self-efficacy and behavior. Methods We conducted a cross-sectional survey of pediatric residents in a single large freestanding children's hospital distributed via an institutional listserv and administered online. The survey included opinion-rating of statements regarding POCUS and barriers to training. We also offered a two-week POCUS course with online modules and hands-on scanning. Participating residents completed pre- and post-course knowledge assessments and follow-up surveys up to 12 months following the course to assess POCUS use and self-report confidence on POCUS indications, acquisition, interpretation, and clinical application. Results Forty-nine respondents were included in the survey representing all three pediatric levels with 16 specialty interest areas. Ninety-six percent of trainees reported that POCUS is an important skill in pediatrics. Ninety-two percent of trainees reported that residency programs should teach residents how to use POCUS. The most important perceived barriers to POCUS training were scheduling availability for POCUS rotations and lack of access to an ultrasound machine. Fourteen participants completed the pre- and post-course knowledge tests, with eight and six participants also completing the six- and 12-month follow-up surveys, respectively. Self-ratings of confidence were significantly improved post-intervention in indications (P = 0.007), image acquisition (P = 0.002), interpretation (P = 0.002), and clinical application (P = 0.004). This confidence improvement was sustained up to 6-12 months (P = 0.004-0.032). Participants also reported higher categorical POCUS use after course completion (P = 0.031). Conclusions Pediatric trainees perceive POCUS as an important skill, hold favorable opinions towards the use of POCUS, and support POCUS training within a pediatric residency. A POCUS course can improve resident POCUS knowledge, instill confidence, and motivate higher POCUS use. Further study is needed to evaluate POCUS applications in pediatric medicine to develop a standardized POCUS curriculum and establish a training guideline for pediatric residency.
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Affiliation(s)
| | - Marc Delaney
- Pediatrics, Children's National Hospital, Washington, USA
| | | | | | - Heather Gordish-Dressman
- Pediatrics, George Washington University School of Medicine and Health Sciences, Washington, USA
| | - Sonali Basu
- Pediatric Critical Care Medicine, Children's National Hospital, Washington, USA
| | - Jeremy Kern
- Hospital Medicine, Children's National Hospital, Washington, USA
| | - Angela Maxwell
- Pediatric Emergency Medicine, Children's National Hospital, Washington, USA
| | - Alyssa Abo
- Pediatric Emergency Medicine, Children's National Hospital, Washington, USA
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20
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Lin-Martore M, Firnberg MT, Kohn MA, Kornblith AE, Gottlieb M. Diagnostic accuracy of point-of-care ultrasonography for intussusception in children: A systematic review and meta-analysis. Am J Emerg Med 2022; 58:255-264. [PMID: 35749802 DOI: 10.1016/j.ajem.2022.06.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Accepted: 06/10/2022] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES Ileocolic intussusception can be challenging to diagnose due to vague complaints, but rapid diagnosis and treatment can help prevent morbidity and mortality. Prior research has focused on radiologic ultrasound, with more recent studies focusing on point-of-care ultrasonography (POCUS). This systematic review and meta-analysis assesses the diagnostic accuracy of POCUS for children with suspected ileocolic intussusception. METHODS PubMed, Embase, CINAHL, LILACS, the Cochrane databases, Google Scholar, conference abstracts, and bibliographies of selected articles were searched for studies evaluating the accuracy of POCUS for the diagnosis of intussusception in children. Data were dual extracted into a predefined worksheet, and quality analysis was performed with the QUADAS-2 tool. Data were summarized, and a meta-analysis was performed. RESULTS Eleven studies (n = 2400 children) met our inclusion criteria. Overall, 14.4% of children had intussusception. POCUS was 95.1% (95% CI: 90.3% to 97.2%) sensitive and 98.1% (95% CI: 95.8% to 99.2%) specific with a positive likelihood ratio of 50 (95% CI: 23 to 113) and a negative likelihood ratio of 0.05 (95% CI: 0.03 to 0.09). CONCLUSIONS POCUS has excellent diagnostic accuracy for intussusception in children presenting to the emergency department.
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Affiliation(s)
- Margaret Lin-Martore
- Department of Emergency Medicine and Department of Pediatrics, University of California, San Francisco, CA, United States of America
| | - Maytal T Firnberg
- Department of Emergency Medicine and Department of Pediatrics, University of California, San Francisco, CA, United States of America
| | - Michael A Kohn
- Department of Epidemiology & Biostatistics, University of California, San Francisco, CA, United States of America
| | - Aaron E Kornblith
- Department of Emergency Medicine and Department of Pediatrics, University of California, San Francisco, CA, United States of America
| | - Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, United States of America
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Meggitt A, Way DP, Iyer MS, Mahan JD, Gold D. Residents' Perspective on Need for Point-of-Care Ultrasound Education During Pediatric Residency. Hosp Pediatr 2022; 12:607-617. [PMID: 35510494 DOI: 10.1542/hpeds.2021-006444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
OBJECTIVES Many medical disciplines incorporate point-of-care ultrasound (POCUS) into their practice. Despite well-defined applications, POCUS has not been widely adopted in pediatrics and is not commonly taught during residency. Our objective was to profile the current state of POCUS education in pediatric residency training from the resident perspective. METHODS We surveyed pediatric trainees about their POCUS education, general opinions about POCUS, and perceived barriers to POCUS training in residency. We distributed the survey to a random sample of Ohio pediatric residents, stratified by program size and training level. Descriptive statistics were used to characterize responses. RESULTS We sampled 66.4% of the population (371 of 559) of Ohio pediatric residents and achieved a response rate of 59.3%. Only 15% of respondents received POCUS training during residency, with 85% having never performed a POCUS scan. Most (86%) desired POCUS education and 67% believed it should be required during residency. Residents felt that POCUS would be useful for procedural guidance (95%), clinical diagnosis (94%), and patient safety (74%). Most residents (61%) believed POCUS education would benefit their careers, particularly those planning on subspecialization. Barriers to POCUS education included lack of an established curriculum (75%), competing educational priorities (58%), and a shortage of qualified instructors (52%). CONCLUSIONS Although Ohio pediatric residents do not receive formal POCUS education in residency, they desire such training and believe it would benefit their future practice. Consensus on scope of practice, development of a standardized curriculum, and increased faculty training in POCUS may help address this educational gap.
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Affiliation(s)
- Austin Meggitt
- University of Colorado, Anschutz Medical Campus, Denver, Colorado
| | - David P Way
- The Ohio State University College of Medicine, Columbus, Ohio
| | - Maya S Iyer
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - John D Mahan
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
| | - Delia Gold
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio
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22
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Kennedy SK, Ferre RM, Rood LK, Nti B, Ehrman RR, Brenner D, Rutz MA, Zahn GS, Herbert AG, Russell FM. Success of implementation of a systemwide point-of-care ultrasound privileging program for emergency medicine faculty. AEM EDUCATION AND TRAINING 2022; 6:e10744. [PMID: 35493291 PMCID: PMC9045579 DOI: 10.1002/aet2.10744] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Revised: 03/10/2022] [Accepted: 03/29/2022] [Indexed: 06/14/2023]
Abstract
OBJECTIVES Point-of-care ultrasound (POCUS) is widely used in the emergency department (ED). Not all practicing emergency physicians received POCUS training during residency, leaving a training gap that is reflected in POCUS privileging. The purpose of this study was to evaluate the success of meeting privileging criteria as well as associated factors, following implementation of a basic POCUS training and privileging program within a large emergency medicine department. METHODS We implemented a POCUS training and privileging program, based on national guidelines, for faculty physicians who worked at one of the following EDs staffed by the same emergency medicine department: a pediatric tertiary site, two tertiary academic sites, and seven community sites. POCUS examinations included aorta, cardiac, first-trimester obstetrics (OB), and extended focused assessment with sonography in trauma. Pediatric emergency medicine faculty were taught soft tissue and thoracic US instead of aorta and OB. Completion of the program required 16 h of didactics, ≥25 quality-assured US examinations by examination type, and passing a series of knowledge-based examinations. Descriptive statistics were calculated. Associations between physician characteristics and successfully becoming privileged in POCUS were modeled using Firth's logistic regression. RESULTS A total of 176 faculty physicians were eligible. A total of 145 (82.4%) achieved basic POCUS privileging during the study period. Different pathways were used including 86 (48.9%) practice-based, nine (5.1%) fellowship-based, and 82 (46.9%) residency-based. POCUS privileging was lower for those working in a community versus academic setting (odds ratio 0.3, 95% confidence interval 0.1-0.9). A greater number of scans completed prior to the privileging program was associated with greater success. CONCLUSIONS Implementation of a POCUS training and privileging program can be successful in a large emergency medicine department that staffs hospitals in a large-scale health care system composed of both academic and community sites. Faculty physicians with at least some prior exposure to POCUS were more successful.
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Affiliation(s)
- Sarah K. Kennedy
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Robinson M. Ferre
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Loren K. Rood
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Benjamin Nti
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Robert R. Ehrman
- Department of Emergency MedicineWayne State University School of MedicineDetroit Medical Center/Sinai‐Grace HospitalDetroitMichiganUSA
| | - Daniel Brenner
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Matt A. Rutz
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Greg S. Zahn
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Audrey G. Herbert
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
| | - Frances M. Russell
- Department of Emergency MedicineIndiana University School of MedicineIndianapolisIndianaUSA
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23
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Silberman AP, Rozenfeld RA, Kessler DO. Core Components of a Pediatric Critical Care Transport Communication Curriculum: A Modified Delphi Approach. Air Med J 2022; 41:217-221. [PMID: 35307146 DOI: 10.1016/j.amj.2021.11.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2021] [Accepted: 11/07/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE Interfacility transport of critically ill infants and children is an essential part of the care of children in the United States. However, there is tremendous variation in how transports are coordinated and performed. Pediatric critical care medicine (PCCM) fellows have differing experiences in their fellowships, and there is no standardized way of training medical command for the transport process. The aim of this study was to use a consensus-building process to establish core components of a PCCM transport curriculum focused on communication. METHODS A national group of experts in transport medicine rated 51 total possible topics for their importance to include in a fellowship curriculum. Three rounds of surveys were completed. RESULTS Fifty-two of 372 invitees (14%) participated in round 1. Consensus was reached to include 15 items in a PCCM curriculum. Twenty of 52 (38%) experts completed round 2, reaching consensus on 2 additional items. Seventeen of 20 (85%) experts completed round 3. No additional items reached consensus. CONCLUSION Experts reached consensus on 17 core components to include in a PCCM fellowship transport communication curriculum. This curriculum could likely be adapted to train providers from different disciplines in the transport process.
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Affiliation(s)
- Anna P Silberman
- Department of Pediatrics, Division of Critical Care Medicine, University of Texas Southwestern Medical Center, Dallas, TX.
| | - Ranna A Rozenfeld
- Department of Pediatrics, Division of Critical Care Medicine, Brown University, Providence, RI
| | - David O Kessler
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Irving Medical Center, New York, NY
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24
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Nti BK, Kennedy S, Sarmiento E, Weinstein E, Russell F. Performance of Pediatric Emergency Medicine Faculty After Point-of-Care Ultrasound Credentialing Implementation. Pediatr Emerg Care 2022; 38:e482-e487. [PMID: 35025189 DOI: 10.1097/pec.0000000000002381] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE As point-of-care ultrasound (POCUS) continues to evolve, a national standardized curriculum for training and credentialing pediatric emergency medicine (PEM) physicians is still lacking. The goal of this study was to assess PEM faculty in performing and interpreting POCUS during implementation of a training curriculum. METHODS Sixteen full-time PEM faculty with either limited or no prior POCUS experience were trained to perform 4 ultrasound studies. Twelve of the 16 completed the training with a goal of credentialing within 12 months of implementation. For each faculty, we assessed competency by comparing precurriculum and postcurriculum test assessments and by evaluating quality of POCUS acquisition and accuracy of interpretation. We also monitored the amount of continuing medical education (CME) hours completed to ensure a minimum didactic component. RESULTS We found a significant improvement in POCUS competency comparing precurriculum to postcurriculum test assessments (55.4% vs 75.6%, P < 0.0002). One thousand two hundred seventy images were submitted over the course of the curriculum. Accuracy, sensitivity, and specificity were 98.23% (confidence interval [CI] = 97.18-98.97), 97.01% (CI = 92.53-99.81), and 98.43% (CI = 97.33-99.81), respectively. Faculty self-rating of image quality was significantly higher than expert reviewer rating of image quality (3.4 ± 0.86 vs 3.2 ± 0.56, P < 0.0001). We found no change in expert reviewer rating of image quality over time. Faculty completed a combined 232.5 CME hours (average, 17.4 ± 10.8), with the majority of hours coming from an institutional POCUS CME workshop. CONCLUSIONS These results show that a structured curriculum can improve PEM faculty POCUS competency.
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Affiliation(s)
| | - Sarah Kennedy
- Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | - Elisa Sarmiento
- Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
| | | | - Frances Russell
- Clinical Ultrasound, Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, IN
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25
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Lam SHF, Berant R, Chang TP, Friedman L, Gold DL, Kornblith AE, Lin-Martore M, Pade KH, Skaugset LM, Toney AG, Wang-Flores H. The P2Network-Advancing Pediatric Emergency Care With Point-of-Care Ultrasound. Pediatr Emerg Care 2022; 38:e1014-e1018. [PMID: 34787985 DOI: 10.1097/pec.0000000000002369] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT Over the last 2 decades, the use of point-of-care ultrasound (POCUS) in pediatric emergency medicine (PEM) has grown exponentially. In 2014, a group of PEM POCUS leaders met and formed the P2Network. The P2Network provides a platform to build collaborative relationships and share expertise among members from various countries and practice settings. It works with educators and researchers within and outside of the field to advance POCUS practice in PEM. As an organization, the P2Network promotes the evidence-based application of POCUS to facilitate and improve care in the PEM setting and addresses issues related to integration of the PEM POCUS practitioner in this nascent field. The P2Network is building and augmenting its infrastructure for PEM POCUS research and education and has already made some progress in the areas, with published manuscripts and ongoing clinical research studies under its sponsorship. Future goals include developing a PEM POCUS research agenda, formalizing teaching and assessment of PEM POCUS skills, and implementing multicenter research studies on potentially high impact applications.
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Affiliation(s)
- Samuel H F Lam
- From the Sutter Medical Center Sacramento, Sacramento, CA
| | | | - Todd P Chang
- Children's Hospital Los Angeles, Los Angeles, CA
| | - Lucas Friedman
- University of California Riverside School of Medicine, Riverside CA
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26
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Harel-Sterling M, McLean LJ. Development of a blended learning curriculum to improve POCUS education in a pediatric emergency medicine training program. CAN J EMERG MED 2022; 24:325-328. [DOI: 10.1007/s43678-022-00264-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2021] [Accepted: 01/07/2022] [Indexed: 11/29/2022]
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27
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Ichihashi K, Nonaka K. Point-of-care ultrasound for children. J Med Ultrason (2001) 2022; 49:639-654. [DOI: 10.1007/s10396-021-01169-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2021] [Accepted: 09/25/2021] [Indexed: 11/29/2022]
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28
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McGinness A, Lin-Martore M, Addo N, Shaahinfar A. The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey. BMC MEDICAL EDUCATION 2022; 22:7. [PMID: 34980087 PMCID: PMC8722332 DOI: 10.1186/s12909-021-03072-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a noninvasive bedside tool with many pediatric applications but is not currently a formal part of pediatric training and practice. Formal surveys of general pediatricians regarding POCUS training are lacking. We aimed to quantify the baseline ultrasound experience and training needs of general pediatricians and pediatric residents across different practice settings. METHODS In 2020, we sent an online survey to 485 current faculty, residents, and graduates from an urban pediatric academic medical center in Northern California. Pediatric subspecialists were excluded. Survey questions about baseline experience, comfort, and perceived usefulness of 20 common POCUS applications were developed by two POCUS experts using existing literature. Chi-squared analysis was used to compare residents versus attendings and to compare attendings practicing in inpatient versus outpatient versus mixed settings. RESULTS Response rate was 20% (98/485). Compared to attendings (n = 73), residents (n = 25) endorsed more exposure to POCUS in medical school (32% vs 5%, p = 0.003) and residency (12% vs 5%, p = 0.003). Respondents endorsed low comfort with POCUS (mean 1.3 out of 5 on Likert scale). Of 20 procedural and diagnostic applications, respondents identified abscess drainage, bladder catheterization, soft tissue, neck, advanced abdominal, and constipation as most useful. Overall, 50% of pediatricians (and 70% of pediatric residents) responded that there were opportunities to use POCUS multiple times a week or more in their clinical practice. CONCLUSIONS There is an unmet demand for POCUS training among general pediatricians and trainees in our study. Although the majority of respondents were not POCUS users, our results could guide future efforts to study the role of POCUS in general pediatrics and develop pediatric curricula.
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Affiliation(s)
- Anelah McGinness
- Department of Graduate Medical Education, PGY-3 resident, University of California San Francisco Benioff Children’s Hospital Oakland, 747 52nd Street, Suite 245, Oakland, CA 94609 USA
| | - Margaret Lin-Martore
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco, 5150 16th St, Box 0632, San Francisco, CA 94143 USA
| | - Newton Addo
- Departments of Medicine and Emergency Medicine, 1001 Potrero Ave, Box 1220, San Francisco, CA 94143 USA
| | - Ashkon Shaahinfar
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, University of California San Francisco, 747 52nd Street, ED Trailer 3, Oakland, CA 94609 USA
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29
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Aichhorn L, Küng E, Schwaberger B. Neonatologist performed lung ultrasound: NPLUS-proposal for a consistent ultrasound terminology. Front Pediatr 2022; 10:1007672. [PMID: 36866083 PMCID: PMC9971559 DOI: 10.3389/fped.2022.1007672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2022] [Accepted: 12/20/2022] [Indexed: 02/16/2023] Open
Affiliation(s)
- Lukas Aichhorn
- Division of Neonatology, Paediatric Intensive Care & Neuropaediatrics, Department of Paediatrics and Adolescent Medicine, Comprehensive Center for Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Erik Küng
- Division of Neonatology, Paediatric Intensive Care & Neuropaediatrics, Department of Paediatrics and Adolescent Medicine, Comprehensive Center for Paediatrics, Medical University of Vienna, Vienna, Austria
| | - Bernhard Schwaberger
- Division of Neonatology, Department of Paediatrics and Adolescent Medicine, Medical University of Graz, Graz, Austria
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30
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Mori T, Nomura O, Takei H, Fukuhara S, Ichihashi K. Implementation and assessment of a pediatric point-of-care ultrasound training course in Japan: a pilot study. J Med Ultrason (2001) 2022; 49:85-93. [PMID: 34677709 PMCID: PMC8532428 DOI: 10.1007/s10396-021-01155-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 08/17/2021] [Indexed: 12/02/2022]
Abstract
PURPOSE The popularity of point-of-care ultrasound (POCUS) has led to the creation of educational guidelines for its use. In Japan, however, a comprehensive training course for POCUS use in pediatric emergency medicine has yet to be developed. The present study aimed to implement a pilot course for pediatric POCUS training in Japan and to compare participants' self-efficacy level before and after the course. METHODS A half-day training course in pediatric POCUS was implemented at a meeting of the Japan Society of Point-of-Care Ultrasound. A standardized training course, including pre-learning materials, live lectures, and hands-on sessions, was developed based on the US consensus educational guidelines. Physicians interested in pediatric POCUS were recruited for participation and completed a self-evaluation survey before and after the course to access their background, self-efficacy in performing selected ultrasound procedures before and after the course, and their overall satisfaction with the course. RESULTS In total, 31 physicians participated. Of these, 25 completed the survey. Ten participants were in post-graduate year (PGY) 1-2, 13 were in PGY 3-5, and eight were in PGY 6 or higher. The post-training self-efficacy score was significantly higher than the pre-course assessment score (86.0 [standard deviation (SD): 19.2] vs. 35.6 [SD 17.6], p = < 0.05, mean difference: 49.6 [95% confidence interval 39.6-61.2]). Furthermore, overall satisfaction with the course was high at 8.6 (SD 1.8). CONCLUSION The present study implemented a pilot training course in pediatric POCUS and found the participants' self-efficacy level to be significantly higher after the course.
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Affiliation(s)
- Takaaki Mori
- Division of Pediatric Emergency Medicine, Department of Pediatric Emergency and Critical Care Medicine, Tokyo Metropolitan Children's Medical Center, 2-8-29 Musashidai, Fuchu, Tokyo, 183-8561, Japan.
| | - Osamu Nomura
- Department of Emergency and Disaster Medicine, Hirosaki University, 5 Zaifu-cho, Hirosaki, Aomori, 035-8562, Japan
| | - Hirokazu Takei
- Department of Emergency Medicine, Hyogo Prefectural Kobe Children's Hospital, 1-6-7 Minatojimaminamicho, Chuo-ku, Kobe, 650-0047, Japan
| | - Shinichi Fukuhara
- Department of Pediatrics, Hyogo Prefectural Awaji Medical Center, 1-1-137 Shioya, Sumoto, Hyogo, 656-0021, Japan
| | - Ko Ichihashi
- Department of Pediatrics, Jichi Medical University Saitama Medical Center, 1-847 Amanuma-cho, Ohmiya-ku, Saitama, 330-8503, Japan
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31
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Mclean LJ, Lewiss RE. Point-of-Care Ultrasound for Physicians in Practice - A Training Model for Specialty Specific and Clinically Relevant Skill Development. POCUS JOURNAL 2022; 7:118-119. [PMID: 36896283 PMCID: PMC9979918 DOI: 10.24908/pocus.v7i1.15433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Point-of-care Ultrasound (POCUS) skills are required competencies for emergency medicine and paediatric emergency medicine training [1,2,3,4]. Over time, more specialties will require these skills of their graduates. Experienced physicians who completed their training before POCUS requirements may ask: How can I gain POCUS skills training and competency? In this perspective piece we describe in-person and asynchronous training programs available to these clinicians in practice. We highlight these programs due to their person-centred design: they maximise the needs of the learner, provide personalised education, and expose them to respected and established POCUS faculty and training centers.
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Affiliation(s)
- Lianne J Mclean
- Division of Emergency Medicine, Department of Paediatrics, The Hospital for Sick Children, University of Toronto Toronto Canada
| | - Resa E Lewiss
- Emergency Medicine & Radiology, Thomas Jefferson University Philadelphia, PA USA
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32
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Yoon SA. Is it time to add point-of-care ultrasound education to pediatric residency curriculum? Clin Exp Pediatr 2022; 65:33-34. [PMID: 34645256 PMCID: PMC8743429 DOI: 10.3345/cep.2021.01060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/13/2021] [Indexed: 01/19/2023] Open
Affiliation(s)
- Shin Ae Yoon
- Department of Pediatrics, Chungbuk National University Hospital, Chungbuk National University College of Medicine, Cheongju, Korea
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33
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Buonsenso D, De Rose C. Implementation of lung ultrasound in low- to middle-income countries: a new challenge global health? Eur J Pediatr 2022; 181:1-8. [PMID: 34216270 PMCID: PMC8254441 DOI: 10.1007/s00431-021-04179-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 01/03/2023]
Abstract
Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. In this paper, we discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting. What is Known: • Pneumonia remains the leading cause of death globally in children under the age of five. The poorest children are the ones most at risk of dying. In the recent years, lung ultrasound has been widely documented as a safe and easy tool for the diagnosis and monitoring of pneumonia and several other respiratory infections and diseases. During the pandemic, it played a primary role to achieve early suspicion and prediction of severe COVID-19, reducing the risk of exposure of healthcare workers to positive patients. However, innovations that can improve diagnosis and treatment allocation, saving hundreds of thousands of lives each year, are not reaching those who need them most. What is New: • We discuss advantages and limits of different tools for the diagnosis of pneumonia in low- to middle-income countries, highlighting potential benefits of a wider access to lung ultrasound in these settings and barriers to its implementation, calling international organizations to ensure the indiscriminate access, quality, and sustainability of the provision of ultrasound services in every setting.
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Affiliation(s)
- Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario, Largo A. Gemelli 8, 00168, Rome, Italy.
- Dipartimento Di Scienze Biotecnologiche Di Base, Cliniche Intensivologiche E Perioperatorie, Università Cattolica del Sacro Cuore, Rome, Italy.
- Global Health Research Institute, Istituto Di Igiene, Università Cattolica del Sacro Cuore, Rome, Italy.
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario, Largo A. Gemelli 8, 00168, Rome, Italy
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34
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Delacruz N, Malia L, Dessie A. Point-of-Care Ultrasound for the Evaluation and Management of Febrile Infants. Pediatr Emerg Care 2021; 37:e886-e892. [PMID: 33273426 DOI: 10.1097/pec.0000000000002300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Febrile infants frequently present to the emergency department (ED) and account for a vulnerable population at significant risk for serious bacterial infection. Appropriate evaluation and management are key to favorable outcomes but can present challenges for providers, especially in EDs where ill children are infrequently seen and pediatric-trained staff may not be available. Point-of-care ultrasound (POCUS) is integrated into the care of adults in the ED but is less commonly used for infants. OBJECTIVE OF REVIEW We present a review of the current literature and proposed approach to using POCUS for bladder catheterization, lumbar puncture (LP), and vascular access in the resuscitation and evaluation of febrile infants. DISCUSSION Point-of-care ultrasound can be a useful adjunct in the evaluation of febrile infants by facilitating higher success rates of infant bladder catheterization, LP, and intraosseous and intravenous (IV) line placement. Ultrasound has been shown to be a reliable method of evaluating bladder volumes before the catheterization of infants, reducing the number of attempts needed to obtain an adequate urine sample for testing and culture. Point-of-care ultrasound has also been shown to improve the yield of LPs in infants. Ultrasound is a rapid and accurate way of identifying the appropriate location and depth of needle insertion. Point-of-care ultrasound has also been shown to facilitate obtaining IV access in infants as well as confirming the proper placement of intraosseous lines. CONCLUSIONS A growing body of evidence suggests that POCUS is a useful adjunct in the initial evaluation and resuscitation of febrile infants. It is the position of both the American Academy or Pediatrics, American College of Emergency Physicians, and the authors of this article that emergency physicians should be familiar with the indications and applications of POCUS in children. This technology should be used as an adjunct to improve success rates when performing bladder catheterization, LP, and obtaining intravenous/intraosseous access for infants.
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Affiliation(s)
- Nicolas Delacruz
- From the Department of Pediatrics, New York Presbyterian-Morgan Stanley Children's Hospital
| | - Laurie Malia
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY
| | - Almaz Dessie
- Department of Emergency Medicine, Division of Pediatric Emergency Medicine, Columbia University Vagelos College of Physicians and Surgeons, New York Presbyterian-Morgan Stanley Children's Hospital, New York, NY
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35
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Good RJ, O'Hara KL, Ziniel SI, Orsborn J, Cheetham A, Rosenberg A. Point-of-Care Ultrasound Training in Pediatric Residency: A National Needs Assessment. Hosp Pediatr 2021; 11:1246-1252. [PMID: 34625490 DOI: 10.1542/hpeds.2021-006060] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND AND OBJECTIVES As point-of-care ultrasound (POCUS) evolves into a standard tool for the care of children, pediatric residency programs need to develop POCUS training programs. Few POCUS training resources exist for pediatric residents, and little is known about POCUS training in pediatric residencies. We aim to describe pediatric residency leadership perspectives regarding the value of POCUS and to elucidate the current state of POCUS training in pediatric residency programs. METHODS A group of pediatric educators and POCUS experts developed a novel survey followed by cognitive interviews to establish response-process validity. The survey was administered electronically to pediatric residency associate program directors between December 2019 and April 2020. Program characteristics, including region, setting, and size, were used to perform poststratification for analyses. We performed comparative analyses using program and respondent characteristics. RESULTS We achieved a 30% (58 of 196) survey response rate. Although only a minority of respondents (26%) used POCUS in clinical practice, a majority (56%) indicated that all pediatric residents should be trained in POCUS. A majority of respondents also considered 8 of 10 POCUS applications important for pediatric residents. Only 37% of programs reported any POCUS training for residents, primarily informal bedside education. Most respondents (94%) cited a lack of qualified instructors as a barrier to POCUS training. CONCLUSIONS Most pediatric residency programs do not provide residents with POCUS training despite its perceived value and importance. Numerous POCUS applications are considered important for pediatric residents to learn. Future curricular and faculty development efforts should address the lack of qualified POCUS instructors.
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Affiliation(s)
- Ryan J Good
- Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Kimberly L O'Hara
- Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Sonja I Ziniel
- Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Jonathan Orsborn
- Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
| | - Alexandra Cheetham
- Division of Emergency Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio
| | - Adam Rosenberg
- Department of Pediatrics, School of Medicine, University of Colorado and Children's Hospital Colorado, Aurora, Colorado
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Kwon JH, Lee JH, Ha YR, Park JD. Development of Core Contents of Point-of-Care Ultrasound Curriculum for Pediatric Emergency Medicine Physician Training: A Modified Delphi Survey. CHILDREN (BASEL, SWITZERLAND) 2021; 8:757. [PMID: 34572189 PMCID: PMC8467914 DOI: 10.3390/children8090757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/21/2021] [Revised: 08/25/2021] [Accepted: 08/26/2021] [Indexed: 11/16/2022]
Abstract
BACKGROUND As the frequency of ultrasound use in pediatric emergency departments increases, it is necessary to train pediatric emergency medicine (PEM) physicians on pediatric point-of-care ultrasonography (POCUS). We discussed the core content of POCUS applications and proposed a POCUS training curriculum for PEM physicians in South Korea. METHODS Twenty-three experts were included if had performed over 1500 POCUS scans, had at least three years of experience teaching POCUS to physicians, were POCUS instructors or had completed a certified pediatric POCUS program. Experts rated 61 possible POCUS applications in terms of the importance of their inclusion in a PEM POCUS curriculum using the modified Delphi technique. RESULTS In round one, twelve (52.2%) out of 23 experts responded to the email. Eleven experts satisfied the inclusion criteria. Eleven experts participated in round one of a survey and agreed on 27 (44.3%) out of a total of 61 items. In round two, all 11 experts participated in the survey; they agreed on two (5.9%) of the remaining 34 items, and no items were excluded. CONCLUSION Using the Delphi method, 61 applications were discussed, and a consensus was reached on 29 core applications.
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Affiliation(s)
- Jae-Hyun Kwon
- Department of Emergency Medicine, Bundang CHA Hospital, CHA University School of Medicine, Pocheon 13496, Korea;
| | - Jin-Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 13620, Korea
| | - Young-Rock Ha
- Department of Critical Care Medicine, Seongnam Citizens Medical Center, Seongnam 13290, Korea;
| | - June-Dong Park
- Department of Pediatrics, Seoul National University College of Medicine, Seoul 03080, Korea;
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37
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Gold D, Levine M, Hsu D, Way DP, Shefrin AE, Lam SH, Lewiss R, Marin JR. Design of a point-of-care ultrasound curriculum for pediatric emergency medicine fellows: A Delphi study. AEM EDUCATION AND TRAINING 2021; 5:e10700. [PMID: 34901685 PMCID: PMC8637871 DOI: 10.1002/aet2.10700] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Revised: 09/10/2021] [Accepted: 10/05/2021] [Indexed: 06/14/2023]
Abstract
OBJECTIVES There has been a steady increase in the growth and utilization of point-of-care ultrasound (POCUS) in pediatric emergency medicine (PEM). POCUS has been established as an Accreditation Council for Graduate Medical Education (ACGME) core requirement for accreditation of PEM fellowship programs. Despite this requirement, training guidelines regarding POCUS knowledge and skills have yet to be developed. The purpose of this project was to develop a curriculum and a competency checklist for PEM fellow POCUS education. METHODS We formed a core leadership group based on expertise in one or more key areas: PEM, POCUS, curriculum development, or Delphi methods. We recruited 29 PEM POCUS or ultrasound education experts from North America to participate in a three-round electronic Delphi project. The first Delphi round asked experts to generate a list of the core POCUS knowledge and skills that a PEM fellow would need during training to function as an autonomous practitioner. Subsequent rounds prioritized the list of knowledge and skills, and the core leadership group organized knowledge and skills into global competencies and subcompetencies. RESULTS The first Delphi round yielded 61 POCUS areas of knowledge and skills considered important for PEM fellow learning. After two subsequent Delphi rounds, the list of POCUS knowledge and skills was narrowed to 38 items that addressed elements of six global competencies. The core leadership group then revised items into subcompetencies and categorized them under global competencies, developing a curriculum that defined the scope (depth of content) and sequence (order of teaching) of these POCUS knowledge and skill items. CONCLUSIONS This expert, consensus-generated POCUS curriculum provides detailed guidance for PEM fellowships to incorporate POCUS education into their programs. Our curriculum also identifies core ultrasound knowledge and skills needed by PEM fellows to perform the specific POCUS applications recommended in prior publications.
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Affiliation(s)
- Delia Gold
- Nationwide Children’s Hospital and The Ohio State University College of MedicineColumbusOhioUSA
| | - Marla Levine
- Vanderbilt University Medical CenterVanderbilt University School of MedicineNashvilleTennesseeUSA
| | - Deborah Hsu
- Texas Children’s HospitalBaylor College of MedicineHoustonTexasUSA
| | - David P. Way
- Department of Emergency MedicineThe Ohio State University College of MedicineColumbusOhioUSA
| | - Allan E. Shefrin
- Children’s Hospital of Eastern Ontario/University of OttawaOttawaOntarioCanada
| | | | - Resa Lewiss
- Thomas Jefferson University HospitalPhiladelphiaPennsylvaniaUSA
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Cramer N, Cantwell L, Ong H, Sivasankar SM, Graff D, Lawson SL, Wilson PM, Noorbakhsh KA, Mickley M, Zuckerbraun NS, Sobolewski B, Soung JK, Azhdam DB, Wagner Neville DN, Hincapie MR, Marin JR. Pediatric emergency medicine fellowship point-of-care ultrasound training in 2020. AEM EDUCATION AND TRAINING 2021; 5:e10643. [PMID: 34568713 PMCID: PMC8448484 DOI: 10.1002/aet2.10643] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Revised: 06/24/2021] [Accepted: 06/30/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVES The primary objective was to survey pediatric emergency medicine (PEM) leaders and fellows regarding point-of-care ultrasound (POCUS) training in PEM fellowship programs, including teaching methods, training requirements, and applications taught. Secondary objectives were to compare fellows' and program leaders' perceptions of fellow POCUS competency and training barriers. METHODS This was a cross-sectional survey of U.S. PEM fellows and fellowship program leaders of the 78 fellowship programs using two online group-specific surveys exploring five domains: program demographics; training strategies and requirements; perceived competency; barriers, strengths, and weaknesses of POCUS training; and POCUS satisfaction. RESULTS Eighty-three percent (65/78) of programs and 53% (298/558) of fellows responded. All participating PEM fellowship programs included POCUS training in their curriculum. Among the 65 programs, 97% of programs and 92% of programs utilized didactics and supervised scanning shifts as educational techniques, respectively. Sixty percent of programs integrated numerical benchmarks and 49% of programs incorporated real-time, hands-on demonstration as training requirements. Of the 19 POCUS applications deemed in the literature as core requirements for fellows, at least 75% of the 298 fellows reported training in 13 of those applications. Although less than half of fellows endorsed competency for identifying intussusception, ultrasound-guided pericardiocentesis, and transvaginal pregnancy evaluation, a higher proportion of leaders reported fellows as competent for these applications (40% vs. 68%, p ≤ 0.001; 21% vs. 39%, p = 0.003; and 21% vs. 43%, p ≤ 0.001). Forty-six percent of fellows endorsed a lack of PEM POCUS evidence as a training barrier compared to 31% of leaders (p = 0.02), and 39% of leaders endorsed a lack of local financial support as a training barrier compared to 23% of fellows (p = 0.01). CONCLUSIONS Although most PEM fellowship programs provide POCUS training, there is variation in content and requirements. Training does conform to many of the expert recommended guidelines; however, there are some discrepancies and perceived barriers to POCUS training remain.
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Affiliation(s)
- Natan Cramer
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Lauren Cantwell
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
| | - Hilary Ong
- Department of Emergency Medicine and Trauma ServicesChildren's National HospitalWashingtonDCUSA
- Present address:
Department of Emergency MedicineUCSF Benioff Children's HospitalSan FranciscoCaliforniaUSA
| | - Shyam M. Sivasankar
- Department of Emergency MedicineStanford University School of MedicinePalo AltoCaliforniaUSA
- Dell Medical School Department of PediatricsAustinTexasUSA
| | - Danielle Graff
- Division of Emergency MedicineDepartment of PediatricsNorton Children's HospitalUniversity of Louisville School of MedicineLouisvilleKentuckyUSA
| | - Simone L. Lawson
- Department of Emergency Medicine and Trauma ServicesChildren's National HospitalWashingtonDCUSA
| | - Paria M. Wilson
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Kathleen A. Noorbakhsh
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Megan Mickley
- Section of Pediatric Emergency MedicineDepartment of PediatricsChildren's Hospital ColoradoAuroraColoradoUSA
| | - Noel S. Zuckerbraun
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Brad Sobolewski
- Department of PediatricsUniversity of Cincinnati College of MedicineCincinnatiOhioUSA
- Division of Emergency MedicineCincinnati Children's Hospital Medical CenterCincinnatiOhioUSA
| | - Jane K. Soung
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Devora B. Azhdam
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | | | - Mark R. Hincapie
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
| | - Jennifer R. Marin
- Department of Emergency MedicineUPMC Children's Hospital of PittsburghPittsburghPennsylvaniaUSA
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Diagnostic Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine. Emerg Med Clin North Am 2021; 39:509-527. [PMID: 34215400 DOI: 10.1016/j.emc.2021.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Point-of-care ultrasound has become an essential part of pediatric emergency medicine training and practice. It can have significant clinical benefits, including improving diagnostic accuracy and decreasing length of stay, and does not require radiation exposure for patients. In this review, we summarize the current diagnostic point-of-care ultrasound applications in pediatric emergency medicine, their evidence, and techniques.
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van Wassenaer EA, Daams JG, Benninga MA, Rosendahl K, Koot BGP, Stafrace S, Arthurs OJ, van Rijn RR. Non-radiologist-performed abdominal point-of-care ultrasonography in paediatrics - a scoping review. Pediatr Radiol 2021; 51:1386-1399. [PMID: 33837798 PMCID: PMC8266706 DOI: 10.1007/s00247-021-04997-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/06/2020] [Accepted: 02/03/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Historically, US in the paediatric setting has mostly been the domain of radiologists. However, in the last decade, there has been an uptake of non-radiologist point-of-care US. OBJECTIVE To gain an overview of abdominal non-radiologist point-of-care US in paediatrics. MATERIALS AND METHODS We conducted a scoping review regarding the uses of abdominal non-radiologist point-of-care US, quality of examinations and training, patient perspective, financial costs and legal consequences following the use of non-radiologist point-of-care US. We conducted an advanced search of the following databases: Medline, Embase and Web of Science Conference Proceedings. We included published original research studies describing abdominal non-radiologist point-of-care US in children. We limited studies to English-language articles from Western countries. RESULTS We found a total of 5,092 publications and selected 106 publications for inclusion: 39 studies and 51 case reports or case series on the state-of-art of abdominal non-radiologist point-of-care US, 14 on training of non-radiologists, and 1 each on possible harms following non-radiologist point-of-care US and patient satisfaction. According to included studies, non-radiologist point-of-care US is increasingly used, but no standardised training guidelines exist. We found no studies regarding the financial consequences of non-radiologist point-of-care US. CONCLUSION This scoping review supports the further development of non-radiologist point-of-care US and underlines the need for consensus on who can do which examination after which level of training among US performers. More research is needed on training non-radiologists and on the costs-to-benefits of non-radiologist point-of-care US.
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Affiliation(s)
- Elsa A van Wassenaer
- Emma Children's Hospital, Amsterdam UMC, Paediatric Gastroenterology, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands. .,Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Amsterdam Gastroenterology and Metabolism,Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Joost G Daams
- Amsterdam UMC, Medical Library, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, Paediatric Gastroenterology, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Karen Rosendahl
- Department of Radiology, Section of Paediatric Radiology, University Hospital North Norway, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Bart G P Koot
- Emma Children's Hospital, Amsterdam UMC, Paediatric Gastroenterology, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Samuel Stafrace
- Division of Body imaging, Department of Diagnostic Imaging, Sidra Medicine and Weill Cornell Medicine, Doha, Qatar
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Biomedical Research Centre, London, UK
| | - Rick R van Rijn
- Amsterdam UMC, Radiology, University of Amsterdam, Amsterdam, The Netherlands
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Shaahinfar A, Ghazi-Askar ZM. Procedural Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine. Emerg Med Clin North Am 2021; 39:529-554. [PMID: 34215401 DOI: 10.1016/j.emc.2021.04.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
Point-of-care ultrasound can improve efficacy and safety of pediatric procedures performed in the emergency department. This article reviews ultrasound guidance for the following pediatric emergency medicine procedures: soft tissue (abscess incision and drainage, foreign body identification and removal, and peritonsillar abscess drainage), musculoskeletal and neurologic (hip arthrocentesis, peripheral nerve blocks, and lumbar puncture), vascular access (peripheral intravenous access and central line placement), and critical care (endotracheal tube placement, pericardiocentesis, thoracentesis, and paracentesis). By incorporating ultrasound, emergency physicians caring for pediatric patients have the potential to enhance their procedural scope, confidence, safety, and success.
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Affiliation(s)
- Ashkon Shaahinfar
- Division of Emergency Medicine, UCSF Benioff Children's Hospital Oakland, Trailer 3, 747 52nd Street, Oakland, CA 94609, USA; Department of Emergency Medicine, UCSF School of Medicine, 550 16th Street, MH5552, San Francisco, CA, USA.
| | - Zahra M Ghazi-Askar
- Department of Emergency Medicine, Stanford School of Medicine, 300 Pasteur Drive, Room M121, Alway Building MC 5768, Stanford, CA 94305, USA
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42
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White M, Betensky M, Lawson SL, Goldenberg NA. Community-Onset Venous Thromboembolism in Children: Pediatric Emergency Medicine Perspectives. Semin Thromb Hemost 2021; 47:623-630. [PMID: 33971683 DOI: 10.1055/s-0041-1725117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Pediatric venous thromboembolism (VTE) is a condition increasingly encountered by emergency medicine physicians. Unfortunately, despite increased incidence, the diagnosis of pediatric VTE relies on a high index of suspicion from clinicians. Delays in diagnosis and initiation of treatment can lead to poor outcomes in children, including an increased risk of mortality from pulmonary embolism, increased risk of VTE recurrence, and the development of the post-thrombotic syndrome. The majority of pediatric VTE events are associated with the presence of at least one underlying prothrombotic risk. Timely recognition of these risk factors in the emergency department (ED) setting is paramount for a prompt diagnosis and treatment initiation. Compared with children with hospital-acquired VTE, children presenting to the ED with new onset VTE tend to be older (>11 years of age), have a lower incidence of co-morbidities, and present more frequently with a deep venous thrombosis of the lower extremity. Currently, there are no validated pediatric-specific VTE clinical pretest probability tools that reliably assist with the accurate and timely diagnosis of pediatric VTE. Compression ultrasound with Doppler is the most common imaging modality used for VTE diagnosis, and low molecular weight heparins are the most common anticoagulants initiated in children presenting with VTE in the ED. Special consideration should be given to patients who present to the ED already on anticoagulation therapy who may require acute management for clinically-significant bleeding or change in antithrombotic therapy approach for progression/recurrence of VTE.
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Affiliation(s)
- Melissa White
- Division of General Pediatrics and Adolescent Medicine, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Marisol Betensky
- Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Institute of Clinical and Translation Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida
| | - Simone L Lawson
- Departments of Pediatrics and Emergency Medicine, Children's National Medical Center, George Washington University School of Medicine and Health Sciences, Washington, District of Columbia
| | - Neil A Goldenberg
- Division of Hematology, Department of Pediatrics, Johns Hopkins University School of Medicine, Baltimore, Maryland.,Institute of Clinical and Translation Research, Johns Hopkins All Children's Hospital, St. Petersburg, Florida.,Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland
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43
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Musolino AM, Buonsenso D, Massolo AC, Gallo M, Supino MC, Boccuzzi E. Point of care ultrasound in the paediatric acute care setting: Getting to the 'heart' of respiratory distress. J Paediatr Child Health 2021; 57:318-322. [PMID: 33295654 DOI: 10.1111/jpc.15308] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2020] [Revised: 10/27/2020] [Accepted: 11/15/2020] [Indexed: 01/13/2023]
Abstract
Point-of-care ultrasound (POCUS) is a growing interesting tool in the emergency setting. Its usefulness in diagnostic and therapeutic pathway of patients with respiratory distress in addition to clinical evaluation is well established in adult emergency medicine while paediatric specific data, although growing, remain limited. We report a case series of paediatric patients presenting with respiratory distress successfully diagnosed with cardiac dysfunction following POCUS evaluations. Lung POCUS, in combination with cardiac POCUS, is a very useful supplementary diagnostic tool to assess the breathless child and to rapidly identify life-threatening primary etiologies or secondary physiologies. Thus, fast echocardiography is a desirable aid for paediatric emergency physicians and should be supported in all paediatric emergency settings following an adequate training that is mandatory regarding image acquisition and data interpretation.
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Affiliation(s)
- Anna M Musolino
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, A. Gemelli University Polyclinic Foundation, IRCCS, Rome, Italy.,Department of Basic Biotechnological Sciences, Intensivological and Perioperative Clinics, Catholic University of the Sacred Heart, Rome, Italy
| | - Anna C Massolo
- Department of Medical and Surgical Neonatology, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Mariasara Gallo
- Specialization School in Anesthesia, Resuscitation and Pain Therapy, Sapienza University of Rome, Rome, Italy
| | - Maria C Supino
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
| | - Elena Boccuzzi
- Pediatric Emergency Department, Bambino Gesù Children's Hospital, IRCCS, Rome, Italy
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44
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Brant JA, Orsborn J, Good R, Greenwald E, Mickley M, Toney AG. Evaluating a longitudinal point-of-care-ultrasound (POCUS) curriculum for pediatric residents. BMC MEDICAL EDUCATION 2021; 21:64. [PMID: 33468138 PMCID: PMC7816421 DOI: 10.1186/s12909-021-02488-z] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/06/2020] [Accepted: 01/01/2021] [Indexed: 05/18/2023]
Abstract
BACKGROUND POCUS is a growing field in medical education, and an imaging modality ideal for children given the lack of ionizing radiation, ease of use, and good tolerability. A 2019 literature review revealed that no US pediatric residency programs integrated obligatory POCUS curricula. Our objective was to provide a formalized POCUS curriculum over multiple years, and to retrospectively assess improvement in resident skills and comfort. METHODS During intern year, pediatric residents received didactics and hands-on scanning opportunities in basic POCUS applications. Their evaluation tools included pre- and post-surveys and tests, and a final performance exam. In the second and third years of residency, all participants were required to complete 8 hours per year of POCUS content review and additional hands-on training. An optional third-year curriculum was offered to interested residents as career-focused education elective time. RESULTS Our curriculum introduced POCUS topics such as basic and advanced cardiac, lung, skin/soft tissues and procedural based ultrasound to all pediatric residents. Among first-year residents, application-specific results showed POCUS comfort level improved by 61-90%. Completed evaluations demonstrated improvement in their ability to recognize and interpret POCUS images. Second- and third-year residents reported educational effectiveness that was rated 3.9 on a 4-point Likert scale. Four third-year residents took part in the optional POCUS elective, and all reported a change in their practice with increased POCUS incorporation. CONCLUSIONS Our longitudinal pediatric residency POCUS curriculum is feasible to integrate into residency training and exhibits early success.
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Affiliation(s)
- Julia Aogaichi Brant
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA.
| | - Jonathan Orsborn
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA
| | - Ryan Good
- Department of Pediatrics, Section of Pediatric Intensive Care, University of Colorado/Children's Hospital Colorado, Aurora, CO, USA
| | - Emily Greenwald
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA
| | - Megan Mickley
- Department of Pediatrics, Section of Emergency Medicine, University of Colorado/Children's Hospital Colorado, 13123 E 16th Ave, B251, Aurora, CO, 80045, USA
| | - Amanda G Toney
- Department of Pediatrics, Denver Health Medical Center, Denver, CO, USA
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45
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van Rijn RR, Stafrace S, Arthurs OJ, Rosendahl K. Non-radiologist-performed point-of-care ultrasonography in paediatrics - European Society of Paediatric Radiology position paper. Pediatr Radiol 2021; 51:161-167. [PMID: 33211186 PMCID: PMC7796864 DOI: 10.1007/s00247-020-04843-6] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2020] [Revised: 07/07/2020] [Accepted: 09/07/2020] [Indexed: 12/22/2022]
Abstract
Non-radiologist point-of-care ultrasonography (US) is increasingly implemented in paediatric care because it is believed to facilitate a timely diagnosis, such as in ascites or dilated renal pelvicalyceal systems, and can be used to guide interventional procedures. To date, all policy statements have been published by non-radiologic societies. The European Society of Paediatric Radiology hereby issues a position statement on paediatric non-radiologist point-of-care US from the point of view of those leading on children's imaging, i.e. paediatric radiologists. In this position statement, we will address the boundaries, education, credentialing, quality control, reporting and storage of images in paediatric practice.
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Affiliation(s)
- Rick R van Rijn
- Department of Radiology and Nuclear Medicine, Emma Children's Hospital-Amsterdam UMC, University of Amsterdamn, Meibergdreef 9, 1105 AZ, Amsterdam Zuid-Oost, the Netherlands.
| | - Samuel Stafrace
- Department of Diagnostic Imaging, Sidra Medicine, Doha, Qatar
- Weill Cornell Medicine, Doha, Qatar
| | - Owen J Arthurs
- Great Ormond Street Hospital for Children, NHS Foundation Trust, London, UK
- UCL GOS Institute of Child Health, London, UK
- NIHR Great Ormond Street Hospital Biomedical Research Centre, London, UK
| | - Karen Rosendahl
- Department of Radiology, University Hospital of North Norway, Tromsø, Norway
- The Arctic University of Norway, Tromsø, Norway
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46
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Constantine E, Levine M, Abo A, Arroyo A, Ng L, Kwan C, Baird J, Shefrin AE. Core Content for Pediatric Emergency Medicine Ultrasound Fellowship Training: A Modified Delphi Consensus Study. AEM EDUCATION AND TRAINING 2020; 4:130-138. [PMID: 32313859 PMCID: PMC7163196 DOI: 10.1002/aet2.10365] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2019] [Revised: 05/15/2019] [Accepted: 05/20/2019] [Indexed: 05/11/2023]
Abstract
BACKGROUND Pediatric emergency medicine (PEM) point-of-care ultrasound (POCUS) fellowships exist to provide learners with expertise in ultrasound (US) education, administration, and research oversight. Currently, there are no standardized goals or objectives for these programs, resulting in considerable variability in PEM POCUS fellowship training. METHODS A modified Delphi survey of PEM and general emergency medicine (EM) POCUS experts in Canada and the United States was conducted to obtain consensus regarding the most important curricular components of a PEM POCUS fellowship training program. Participants were solicited from the P2 Network mailing list and from PEM and EM POCUS fellowship directors listed on the Society of Clinical Ultrasound Fellowships and the Canadian Society of POCUS-EM Fellowships websites. Curricular components considered as part of the survey included US skills, educational skills, administrative skills, and research requirements. Consensus was considered to have been reached when ≥80% of respondents agreed to either include or exclude the component in fellowship training. RESULTS Round 1 of the survey was sent to 311 participants. A total of 118 (37.9%) completed eligibility for the survey, and 92 (78.0%) met eligibility criteria. Of those, 80 (67.8% of eligible participants) completed the first round of the survey. Round 2 of the survey was sent to those who completed part 1, and 64 (80.0%) completed that round. During Round 1, consensus was achieved for 15 of 75 US applications, seven of seven educational skills, nine of 11 administrative skills, and four of six research requirements. In Round 2 of the survey, consensus was reached on two additional US skills, but no additional administrative skills or research requirements. CONCLUSIONS With a consensus-building process, the core content for PEM POCUS fellowship training was defined. This can help POCUS educators formulate standardized curricula to create consistent training in POCUS fellowship graduates.
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Affiliation(s)
| | - Marla Levine
- University of Texas at AustinDell Medical SchoolDell Children's Medical Center of Central TexasAustinTX
| | - Alyssa Abo
- George Washington University School of Medicine and Health SciencesWashingtonDC
| | - Alex Arroyo
- Department of Emergency MedicineMaimonides Medical CenterBrooklynNY
| | - Lorraine Ng
- Division of Pediatric Emergency MedicineColumbia University Vagelos College of Physicians and SurgeonsNew YorkNY
| | - Charisse Kwan
- Department of PediatricsUniversity of TorontoTorontoOntarioCanada
| | - Janette Baird
- Warren Alpert School of Medicine at Brown University and Injury Prevention CenterProvidenceRI
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47
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Olszynski P, Kim DJ, Ma IWY, Clunie M, Lambos P, Guzowski T, Butz M, Thoma B. The development of a provincial multidisciplinary framework of consensus-based standards for Point of Care Ultrasound at the University of Saskatchewan. Ultrasound J 2019; 11:28. [PMID: 31624937 PMCID: PMC6797680 DOI: 10.1186/s13089-019-0142-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 10/03/2019] [Indexed: 12/23/2022] Open
Abstract
OBJECTIVES The development and adoption of Point-of-Care Ultrasound (POCUS) across disciplines have created challenges and opportunities in implementing training and utilization standards. Within the context of a large, geographically disparate province, we sought to develop a multidisciplinary POCUS framework outlining consensus-based standards. METHODS A core working group of local POCUS leaders from Anesthesia, Emergency Medicine, Family Medicine, Intensive Care, Internal Medicine, Pediatrics, and Trauma, in collaboration with western Canadian colleagues, developed a list of key domains for the framework along with a range of potential standards for each area. The members of the working group and the registrants for a multidisciplinary Roundtable discussion at the University of Saskatchewan's annual POCUS conference (SASKSONO19, Saskatoon, Saskatchewan, March 2nd, 2019) were invited to complete a survey on POCUS standards for each domain. The survey results were presented to and discussed by participants at the Roundtable discussion at SASKSONO19 who reached consensus on modified standards for each domain. The modified standards were considered for endorsement by all conference attendees using an audience-response system. RESULTS The working group proposed standards in eight domains: scope of use, credentialing and privileges, documentation, quality assurance, leadership and governance, teaching, research, and equipment maintenance. Consensus on modified standards was achieved in the 18 participant Roundtable. Each standard was then endorsed by > 90% of conference respondents. CONCLUSION The resulting framework will inform the utilization of POCUS within Saskatchewan. Both this process and its outcomes could inform the development of multidisciplinary POCUS standards within other jurisdictions.
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Affiliation(s)
- Paul Olszynski
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada.
| | - Daniel J Kim
- Department of Emergency Medicine, University of British Columbia, Vancouver, Canada
| | - Irene W Y Ma
- Department of Medicine, University of Calgary, Calgary, Canada
| | - Michelle Clunie
- Department of Anesthesia and Perioperative Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Peggy Lambos
- Department of Pediatrics, University of Saskatchewan, Prince Albert, Canada
| | - Tom Guzowski
- Department of Internal Medicine, University of Saskatchewan, Saskatoon, Canada
| | - Matthew Butz
- Department of Family Medicine, University of Saskatchewan, Regina, Canada
| | - Brent Thoma
- Department of Emergency Medicine, University of Saskatchewan, Saskatoon, Canada
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