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Musolino AM, Tei M, De Rose C, Buonsenso D, Supino MC, Zampogna S, Staiano A, Raponi M, Amendolea A, Colacino V, Gori L, Manganaro A, Ricci R, D'Inzeo V, Grosso S, Villani A, Agostiniani R. Pediatric ultrasound practice in Italy: an exploratory survey. Ital J Pediatr 2024; 50:114. [PMID: 38853266 PMCID: PMC11163714 DOI: 10.1186/s13052-024-01680-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2024] [Accepted: 05/25/2024] [Indexed: 06/11/2024] Open
Abstract
BACKGROUND The aim of this exploratory survey is to describe the current state of US (ultrasound) technique across different pediatric settings nationwide. METHODS A questionnaire was emailed to all members of the Italian Society of Pediatrics, including pediatric residents. The survey was open from December 2021 to March 2022. RESULTS There were 1098 respondents. Seven hundred and seven pediatricians (84.1%) reported any use of US, while 51 (44.3%) residents denied it. The majority of participants (n = 956, 87.1%) reported to have a US machine available within the department, mostly cart-based (n = 516, 66.9%) and provided from 1 to 5 years prior to the survey (n = 330, 42.8%). Lung and neonatal cerebral regions were the most frequently scanned (n = 289, 18.7% and n = 218, 14.1%, respectively). The suspicion of pneumonia or respiratory distress represented the main reasons for performing US in emergency room (n = 390, 78% and n = 330, 66%, respectively). The majority of family pediatricians reported to scan lung and kidney/urinary tract regions (n = 30, 16.9%, and n = 23,12.9%, respectively). Regarding US training, the majority of respondents (n = 358, 34.6%) declared an experience-based education, with a deficient certification enabling the use of US in 71.6% (n = 552) of cases. The most common barriers included the lack of a well-defined training program (n = 627, 57.1%), unavailability of the US machine (n = 196, 17.9%) and legal responsibility concern (n = 175, 15.9%). CONCLUSIONS Despite the growing interest on pediatric US nationally, significant barriers still limit widespread adoption. These obstacles may be addressed through the dissemination of a specific US education plan and providing additional resources.
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Affiliation(s)
- Anna Maria Musolino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Monica Tei
- Clinical Pediatrics, Department of Mother and Child, Siena University Hospital, Viale Bracci 16, Siena, 53100, Italy.
| | - Cristina De Rose
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Danilo Buonsenso
- Department of Woman and Child Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Maria Chiara Supino
- Unit of Emergency Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Stefania Zampogna
- Department Pediatrics, Hospital of Crotone President of SIMEUP (Italian Society of Pediatric Emergency Medicine Urgency), Crotone, Italy
| | - Annamaria Staiano
- Department of Translational Medical Sciences, Section of Pediatrics, University of Naples "Federico II", President of SIP (Italian Society of Pediatric), Naples, Italy
| | - Massimiliano Raponi
- Management and Diagnostic Innovations and Clinical Pathways Research Area, Medical Directorate, Bambino Gesù Children's Hospital, IRCCS, Rome, 00165, Italy
| | | | | | - Laura Gori
- Department of Maternal and Child Health, Santa Chiara Hospital, University of Pisa, Pisa, 56100, Italy
| | - Alessandro Manganaro
- Pathology and Neonatal and Pediatric Intensive Care Unit, University Hospital G. Martino, Messina, Italy
| | - Riccardo Ricci
- Professional Development, Continuing Education and Research, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Victoria D'Inzeo
- Department of Cardiac Surgery, Cardiology and Heart and Lung Transplant, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Salvatore Grosso
- Clinical Pediatrics, Department of Mother and Child, Siena University Hospital, Viale Bracci 16, Siena, 53100, Italy
| | - Alberto Villani
- Unit of General Pediatrics, Department of Emergency, Admission and General Pediatrics, Bambino Gesù Children's Hospital (IRCCS), Rome, Italy
| | - Rino Agostiniani
- Department of Pediatrics and Neonatology, San Jacopo Hospital, Via Ciliegiole 97, 51100, Pistoia, Italy
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Conlon T, Levine JC, Miller-Hance WC, Slesnick T, Riley A, Kwan C, Soni-Patel N, Lu JC. The Role of the Pediatric Echocardiography Laboratory in Supporting Point-Of-Care Ultrasound (POCUS) Initiatives: A Survey from the American Society of Echocardiography Task Force on Cardiac POCUS in Children. J Am Soc Echocardiogr 2023; 36:333-335. [PMID: 36565728 DOI: 10.1016/j.echo.2022.12.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2022] [Revised: 12/13/2022] [Accepted: 12/15/2022] [Indexed: 12/24/2022]
Affiliation(s)
- Thomas Conlon
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Jami C Levine
- Harvard School of Medicine, Boston Children's Hospital, Boston, Massachusetts
| | | | - Timothy Slesnick
- Emory University School of Medicine, Children's Healthcare of Atlanta, Atlanta, Georgia
| | - Alan Riley
- Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Charisse Kwan
- University of Western Ontario, Children's Hospital, London Health Sciences Centre, London, Ontario, Canada
| | | | - Jimmy C Lu
- University of Michigan Congenital Heart Center, Ann Arbor, Michigan
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3
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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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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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Parri N, Berant R, Giacalone M, Jones SD, Friedman N. Dissemination and Use of Point-of-Care Ultrasound by Pediatricians in Europe: A Research in European Pediatric Emergency Medicine Network Collaborative Survey. Pediatr Emerg Care 2022; 38:e1594-e1600. [PMID: 35608533 DOI: 10.1097/pec.0000000000002767] [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: 11/26/2022]
Abstract
OBJECTIVE We surveyed the dissemination and use of point-of-care ultrasound (POCUS), physician training levels, and barriers and limitations to use of POCUS among pediatricians and pediatric emergency medicine (PEM) physicians across Europe and Israel. METHODS A questionnaire was distributed through the PEM section of the European Society for Emergency Medicine and the Research in European Pediatric Emergency Medicine Network. RESULTS A total of 581 physicians from 22 countries fully completed the questionnaire. Participants were primarily pediatric attending physicians (34.9% [203 of 581]) and PEM attending physicians (28.6% [166 of 581]). Most of the respondents, 58.5% (340 of 581), reported using POCUS in their practice, and 61.9% (359/581) had undergone POCUS training. Point-of-care ultrasound courses represented the most common method of becoming proficient in POCUS. Overall, the Focused Assessment with Sonography in Trauma scan was the mostly taught application, with 76.3% (274 of 359). Resuscitative, diagnostic, and procedural POCUS were rated as very useful or useful by the most of respondents.The lack of qualified personnel to train (76.9% [447 of 581]), and the insufficient time for physicians to learn, POCUS (63.7% [370 of 581]) were identified as the main limitations to POCUS implementation. CONCLUSIONS The dissemination of pediatric POCUS in the European and Israeli centers we surveyed is limited, and its applications are largely restricted to the Focused Assessment with Sonography in Trauma examination. This is likely related to lack of training programs. In contrast, the potential value of use of POCUS in PEM practice is recognized by the majority of respondents.
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Affiliation(s)
- Niccolò Parri
- From the Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Ron Berant
- Emergency Department, Schneider Children's Medical Center of Israel, Petah Tikva, Israel
| | - Martina Giacalone
- From the Department of Emergency Medicine and Trauma Center, Meyer University Children's Hospital, Florence, Italy
| | - Sarah Dianne Jones
- Department of Emergency Medicine, Alder Hey Alder Hey Children's NHS Foundation Trust, Liverpool, England, United Kingdom
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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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A Healthcare Physician Can Be Trained to Perform Intestinal Ultrasound in Children With Inflammatory Bowel Disease. J Pediatr Gastroenterol Nutr 2022; 74:e143-e147. [PMID: 35262517 DOI: 10.1097/mpg.0000000000003442] [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: 12/10/2022]
Abstract
OBJECTIVES Training healthcare physicians to perform intestinal ultrasound (IUS) during outpatient visits with equal accuracy as radiologists could improve clinical management of IBD patients. We aimed to assess whether a healthcare-physician can be trained to perform IUS, with equal accuracy compared with experienced radiologists in children with iBD, and to assess inter-observer agreement. METHODS Consecutive children, 6 to 18 years with IBD or suspicion of IBD, who underwent ileo-colonoscopy were enrolled. iUS was performed independently by a trained healthcare-physician and a radiologist in 1 visit. Training existed of an international training curriculum for IUS. Operators were blinded for each other's IUS, and for the ileocolonoscopy. Difference in accuracy of IUS by the healthcare-physician and radiologist was assessed using areas under the ROC curve (AUROC). Inter-observer variability was assessed in terminal ileum (TI), transverse colon (TC) and descending-colon (DC), for disease activity (ie, bowel wall thickness [BWT] >2 mm with hyperaemia or fat-proliferation, or BWT >3 mm). RESULTS We included 73 patients (median age 15, interquartile range [IQR]:13-17, 37 [51%] female, 43 [58%] with Crohn disease). AUROC ranged between 0.71 and 0.81 for the healthcare-physician and between 0.67 and 0.79 for radiologist (P > 0.05). Inter-observer agreement for disease activity per segment was moderate (K: 0.58 [SE: 0.09], 0.49 [SE: 0.12], 0.52 [SE: 0.11] respectively for TI, TC, and DC). CONCLUSIONS A healthcare- physician can be trained to perform IUS in children with IBD with comparable diagnostic accuracy as experienced radiologists. The interobserver agreement is moderate. Our findings support the usage of IUS in clinical management of children with IBD.
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Russell FM, Kennedy SK, Rood LK, Nti B, Herbert A, Rutz MA, Palmer M, Ferre RM. Design and implementation of a basic and global point of care ultrasound (POCUS) certification curriculum for emergency medicine faculty. Ultrasound J 2022; 14:10. [PMID: 35182232 PMCID: PMC8858359 DOI: 10.1186/s13089-022-00260-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 02/01/2022] [Indexed: 11/10/2022] Open
Abstract
Point of care ultrasound (POCUS) use in the emergency department is associated with improved patient outcomes and increased patient satisfaction. When used for procedural guidance, it has been shown to increase first pass success and decrease complications. As of 2012, ultrasound has been identified as a core skill required for graduating emergency medicine (EM) residents. Despite this, only a minority of EM faculty who trained prior to 2008 are credentialed in POCUS. Half of all EM training programs in the United States have less than 50% of their faculty credentialed to perform and teach POCUS to learners. As the use of POCUS continues to grow in medicine, it is especially important to have a pathway for faculty to attain competence and become credentialed in POCUS. The goal of this paper was to outline an implementation process of a curriculum designed to credential EM faculty in POCUS.
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Affiliation(s)
- Frances M Russell
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA.
| | - Sarah K Kennedy
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Loren K Rood
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Benjamin Nti
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Audrey Herbert
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Matt A Rutz
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Megan Palmer
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
| | - Robinson M Ferre
- Department of Emergency Medicine, Indiana University School of Medicine, 720 Eskenazi Ave, Fifth Third Faculty Office Building, 3rd Floor Emergency Medicine Office, Indianapolis, IN, 46202, USA
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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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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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Abo AM, Alade KH, Rempell RG, Kessler D, Fischer JW, Lewiss RE, Raio CC, Marin JR. Credentialing Pediatric Emergency Medicine Faculty in Point-of-Care Ultrasound: Expert Guidelines. Pediatr Emerg Care 2021; 37:e1687-e1694. [PMID: 30624416 DOI: 10.1097/pec.0000000000001677] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
ABSTRACT As point-of-care ultrasound (POCUS) becomes standard practice in pediatric emergency medicine (PEM), it is important to have benchmarks in place for credentialing PEM faculty in POCUS. Faculty must be systematically trained and assessed for competency in order to be credentialed in POCUS and granted privileges by an individual institution. Recommendations on credentialing PEM faculty are needed to ensure appropriate, consistent, and responsible use of this diagnostic and procedural tool. It is our intention that these guidelines will serve as a framework for credentialing faculty in PEM POCUS.
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Affiliation(s)
- Alyssa M Abo
- From the Departments of Pediatrics and Emergency Medicine, George Washington University School of Medicine and Health Sciences, Washington, DC
| | - Kiyetta H Alade
- Department of Pediatrics, Baylor College of Medicine, Houston, TX
| | - Rachel G Rempell
- Department of Pediatrics, Perelman School of Medicine at the University of Pennsylvania, Philadelphia, PA
| | - David Kessler
- Departments of Pediatrics and Emergency Medicine, Columbia University College of Physicians and Surgeons, New York, NY
| | - Jason W Fischer
- Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Resa E Lewiss
- Department of Emergency Medicine, Thomas Jefferson University, Philadelphia, PA
| | - Christopher C Raio
- Department of Emergency Medicine, Good Samaritan Hospital Medical Center, West Islip, NY
| | - Jennifer R Marin
- Departments of Pediatrics and Emergency Medicine, University of Pittsburgh, Pittsburgh, PA
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12
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Acuña J, Rubin M, Hahn B, Das D, Kapoor M, Adhikari S, Greenstein J. Point-of-Care Ultrasound in United States Pediatric Emergency Medicine Fellowship Programs: The Current State of Practice and Training. Pediatr Emerg Care 2021; 37:e1181-e1185. [PMID: 32118834 DOI: 10.1097/pec.0000000000001955] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES In 2015, the American Academy of Pediatrics (AAP) released a policy statement regarding point-of-care ultrasonography (POCUS) by pediatric emergency physicians, which included recommendations on education and training. In the 3 years since the AAP policy statement and its accompanying technical report were published, it is unclear which aspects of the recommendations set forth by this policy have been instituted by POCUS programs throughout the country. The objective of this study was to conduct a survey of pediatric emergency medicine (PEM) fellowship directors throughout the United States regarding the current state of education and training of POCUS in their department. METHODS We conducted an online survey of all PEM fellowship program directors in the United States between April 1, 2018, and July 31, 2018. RESULTS Of the 78 PEM fellowship program directors contacted, 62 (79.5%) responded. The majority reported having an ultrasound curriculum in place to educate their fellows (77%). Fellows are being taught using a variety of educational strategies. The most commonly reported barriers were lack of qualified faculty available for training (62.9%), lack of confidence or comfort in using the existing ultrasound machine(s) in their department (54.8%), and physician resistance to using new technology (50%). The majority of programs reported having processes in place for credentialing (56%) and quality assurance (72.6%). Whereas 77.4% have a system for archiving POCUS studies after they are performed, only half of the programs report utilization of middleware for their archival system. Compliance with documentation varied significantly between programs. CONCLUSIONS Our survey results demonstrate that, although there is still room for improvement, POCUS programs have succeeded in many of the goals set forth by the 2015 AAP policy statement, such as establishing and growing an ultrasound curriculum and using various strategies to educate PEM fellows.
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Affiliation(s)
- Josie Acuña
- From the Department of Emergency Medicine, The University of Arizona, Tucson, AZ
| | - Marina Rubin
- Department of Emergency Medicine, Newark Beth Israel, Newark, NJ
| | - Barry Hahn
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island
| | - Devjani Das
- Department of Emergency Medicine, New York Presbyterian/Columbia University Medical Center, New York, NY
| | - Monica Kapoor
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island
| | - Srikar Adhikari
- From the Department of Emergency Medicine, The University of Arizona, Tucson, AZ
| | - Joshua Greenstein
- Department of Emergency Medicine, Staten Island University Hospital, Northwell Health, Staten Island
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13
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Buonsenso D, Malamisura M, Musolino AM. Point-of-Care Ultrasound Training Programs Across Italian Pediatric Residency Schools: A National Survey. Pediatr Emerg Care 2021; 37:e1528-e1530. [PMID: 32433456 DOI: 10.1097/pec.0000000000002107] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION The role of point-of-care ultrasound (POCUS) in routine clinical practice is rapidly growing, whereas adult specialties have already included training programs regarding this topic; pediatric residency schools are still late on this topic, particularly in Italy. METHODS We performed an online anonymous survey to Italian residents. The online survey has been submitted to the resident representatives of each pediatric residency school in Italy by the Italian Observatory of Pediatric Residents; each representative in turn distributed it to the pediatric residents of his own school. RESULTS Three sixty-one residents responded to the survey. Only 7.8% of residents declared that in their residency school, an official training program on POCUS exists, although more than 95% of respondents declared that such a training would be of primary importance for their future practice. Most residents do not know how to use an ultrasound machine nor the differences between different probes. CONCLUSIONS Our results demonstrate that POCUS training is still missing in Italy. Given the growing number of evidences of the benefits from including POCUS in clinical practice and patient evaluation, efforts are needed to fill this gap, in Italy and, probably, in most European countries. Such a training will definitely help the new generation of pediatricians improve their curriculum and, therefore, child health.
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Affiliation(s)
| | | | - Anna Maria Musolino
- Pediatric Emergency Department, Bambino Gesù Children Hospital, IRCCS, Rome, Italy
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14
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Camilo GB, Toledo GC, Olímpio H, Dias EN, Oliveira BLD, Ferreira JP, Mendes PDFB, Bastos MG. Teaching point-of-care transfontanellar ultrasound for pediatricians and medical students. J Pediatr (Rio J) 2021; 97:651-657. [PMID: 33713629 PMCID: PMC9432132 DOI: 10.1016/j.jped.2021.01.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2020] [Revised: 01/26/2021] [Accepted: 01/26/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The authors aim to evaluate the "point-of-care" transfontanellar ultrasound (TU) as an extension to pediatric physical examination and suggest a TU teaching protocol. METHODS The students were randomly divided into two groups, group A (12 participants) and group B (15 participants). The first group only received theoretical training, while the second group received theoretical and practical training. A third group, group C, included 15 pediatricians and interns who also received theoretical and practical training. All the participants underwent multiple-choice testing before and after a four-hour short course on TU. Six months later, another evaluation was performed to analyze the retained knowledge. Furthermore, a questionnaire based on the Likert scale was administered to evaluate satisfaction. RESULTS The cognitive evaluation (maximum score=10 points) before and after training increased in group A from 4,0±1,04 to 7,5±1,2 (p<0.001) and, 6 months later, to 6,5±1,16 (p<0.003); in group B from 3,8±1,24 to 8,8±1,01 (p<0.001) and, 6 months later, to 8,46±0,91 (p<0.001); and in group C from 6,0±0,75 to 9,0±0,75 (p<0.001) and, 6 months later, to 8,8±0,77 (p<0.001). The average satisfaction estimated by the Likert scale was over 80% for all questions. CONCLUSION Cognitive assessment before and after classes and training reveals progress in learning, with knowledge retention in 6 months. Theoretical-practical courses are well accepted.
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Affiliation(s)
- Gustavo Bittencourt Camilo
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Pneumologia, Programa de Pós-graduação em Ciências Médica, Rio de Janeiro, RJ, Brazil.
| | - Gabriela Cumani Toledo
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil; Hospital e Maternidade Teresinha de Jesus (HMTJ), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Hebert Olímpio
- Universidade do Estado do Rio de Janeiro (UERJ), Departamento de Pneumologia, Programa de Pós-graduação em Ciências Médica, Rio de Janeiro, RJ, Brazil
| | - Eleusa Nogueira Dias
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Bianca Lopes de Oliveira
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | - Júlia Perches Ferreira
- Faculdade de Ciências Médicas e da Saúde de Juiz de Fora (Suprema), Departamento de Radiologia, Juiz de Fora, MG, Brazil
| | | | - Marcus Gomes Bastos
- Universidade Federal de Juiz de Fora (UFJF), Programa de Pós-graduação em Saúde Brasileira, Juiz de Fora, MG, Brazil; Universidade Federal de Juiz de Fora (UFJF), Departamento de Nefrologia, Juiz de Fora, MG, Brazil
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15
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Alade KH, Marin JR, Constantine E, Ekpenyong A, Farrell SE, Horowitz R, Hsu D, Kwan CW, Ng L, Leonard PJ, Lewiss RE. Development of a novel pediatric point-of-care ultrasound question bank using a modified Delphi process. AEM EDUCATION AND TRAINING 2021; 5:e10651. [PMID: 34527846 PMCID: PMC8427181 DOI: 10.1002/aet2.10651] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/27/2021] [Revised: 07/08/2021] [Accepted: 07/11/2021] [Indexed: 06/13/2023]
Abstract
BACKGROUND AND OBJECTIVES Measuring pediatric emergency medicine (PEM) fellow competency in point-of-care ultrasound (POCUS) is important for ensuring adequate training and performance. Assessment may include direct observation, image review, quality assessment, and written examination. The purpose of this study was to develop a pediatric POCUS question bank that could subsequently be used as a POCUS assessment for graduating PEM fellows. METHODS We organized a 10-person question writing group (QWG). Eight hold expertise in POCUS and two hold expertise in medical education. Members of the QWG created questions within four domains: interpretation/diagnosis (50% of questions), anatomy (30%), physics (10%), and pitfalls (10%). POCUS faculty ascertained content validity and the medical education faculty revised questions for syntax and readability. In 2016, we recruited 31 pediatric POCUS experts. The majority were members of the P2 Network, an international group of experts and leaders in PEM POCUS, to participate in three iterative rounds of a modified Delphi process to review, revise, and establish consensus on the question bank. RESULTS Thirty-one pediatric POCUS experts participated in the three rounds of the modified Delphi process and evaluated 437 questions developed by the expert panel. Forty-nine percent (n = 216) of the questions were accepted in round 1, 30% (n = 130) in round 2, and 11% (n = 47) in the final round. The final question bank included 393 questions covering 17 pediatric POCUS applications. CONCLUSION We developed a 393-question bank to aid in the assessment of PEM POCUS competency. Future work includes piloting the questions with PEM fellows to evaluate the response process and implementing the assessment tool to establish a minimum passing score.
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Affiliation(s)
| | | | | | - Atim Ekpenyong
- University of California–San DiegoSan DiegoCaliforniaUSA
| | | | | | | | - Charisse W. Kwan
- Children's HospitalLondon Health Sciences CentreLondonOntarioCanada
| | - Lorraine Ng
- Columbia University Irving Medical CenterNew YorkNew YorkUSA
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16
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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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17
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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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18
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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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19
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Alerhand S, Tay ET. Point-of-care ultrasound for confirmation of gastrostomy tube replacement in the pediatric emergency department. Intern Emerg Med 2020; 15:1075-1079. [PMID: 32133576 DOI: 10.1007/s11739-020-02294-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2019] [Accepted: 02/13/2020] [Indexed: 01/01/2023]
Abstract
Gastrostomy tubes (G-tubes) are frequently used in children for feeding and nutrition. Complications related to G-tubes (and G-buttons) in children represent a common presentation to the emergency department (ED). G-tube replacement is usually performed by pediatric emergency medicine physicians. Misplacement may lead to tract disruption, perforation, fistula tract formation, or feeding into the peritoneum. Contrast-enhanced radiographs are traditionally used for confirmation. In addition to a longer length-of-stay, repeat ED visits result in repeated radiation exposure. The use of point-of-care ultrasound (POCUS) instead of radiography avoids this exposure to ionizing radiation. Here, we describe three patients who presented with G-tube complications in whom POCUS alone performed by pediatricians was used for confirmation of the tubes' replacement. Two children presented to the ED with G-tube dislodgement, and one child presented with a ruptured balloon. In all three cases, a new G-tube was replaced at the bedside using POCUS guidance without the need for further radiographic studies. There were no known ED or clinic returns for G-tube complaints over the next 30 days. This is the first report of pediatricians using POCUS to guide and confirm G-tube replacement in children. The success of these cases suggests the technique's feasibility. Future prospective studies are needed to evaluate the learning curves, diagnostic accuracy, ED length-of-stay, and use of confirmatory imaging.
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Affiliation(s)
- Stephen Alerhand
- Department of Emergency Medicine, Rutgers New Jersey Medical School, Newark, NJ, 07103, USA.
| | - Ee Tein Tay
- Ronald O. Perelman Department of Emergency Medicine, New York University School of Medicine, New York, NY, 10016, USA
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20
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Marin JR, Rodean J, Hall M, Alpern ER, Aronson PL, Chaudhari PP, Cohen E, Freedman SB, Morse RB, Peltz A, Samuels-Kalow M, Shah SS, Simon HK, Neuman MI. Trends in Use of Advanced Imaging in Pediatric Emergency Departments, 2009-2018. JAMA Pediatr 2020; 174:e202209. [PMID: 32761186 PMCID: PMC7400208 DOI: 10.1001/jamapediatrics.2020.2209] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Importance There is increased awareness of radiation risks from computed tomography (CT) in pediatric patients. In emergency departments (EDs), evidence-based guidelines, improvements in imaging technology, and availability of nonradiating modalities have potentially reduced CT use. Objective To evaluate changes over time and hospital variation in advanced imaging use. Design, Setting, and Participants This cross-sectional study assessed 26 082 062 ED visits by children younger than 18 years from the Pediatric Health Information System administrative database from January 1, 2009, through December 31, 2018. Exposures Imaging. Main Outcomes and Measures The primary outcome was the change in CT, ultrasonography, and magnetic resonance imaging (MRI) rates from January 1, 2009, to December 31, 2018. Imaging for specific diagnoses was examined using all patient-refined diagnosis related groups. Secondary outcomes were hospital admission and 3-day ED revisit rates and ED length of stay. Results There were a total of 26 082 062 visits by 9 868 406 children (mean [SD] age, 5.59 [5.15] years; 13 842 567 [53.1%] male; 9 273 181 [35.6%] non-Hispanic white) to 32 US pediatric EDs during the 10-year study period, with 1 or more advanced imaging studies used in 1 919 283 encounters (7.4%). The proportion of ED encounters with any advanced imaging increased from 6.4% (95% CI, 6.2%-6.2%) in 2009 to 8.7% (95% CI, 8.7%-8.8%) in 2018. The proportion of ED encounters with CT decreased from 3.9% (95% CI, 3.9%-3.9%) to 2.9% (95% CI, 2.9%-3.0%) (P < .001 for trend), with ultrasonography increased from 2.5% (95% CI, 2.5%-2.6%) to 5.8% (95% CI, 5.8%-5.9%) (P < .001 for trend), and with MRI increased from 0.3% (95% CI, 0.3%-0.4%) to 0.6% (95% CI, 0.6%-0.6%) (P < .001 for trend). The largest decreases in CT rates were for concussion (-23.0%), appendectomy (-14.9%), ventricular shunt procedures (-13.3%), and headaches (-12.4%). Factors associated with increased use of nonradiating imaging modalities included ultrasonography for abdominal pain (20.3%) and appendectomy (42.5%) and MRI for ventricular shunt procedures (17.9%) (P < .001 for trend). Across the study period, EDs varied widely in the use of ultrasonography for appendectomy (median, 57.5%; interquartile range [IQR], 40.4%-69.8%) and MRI (median, 15.8%; IQR, 8.3%-35.1%) and CT (median, 69.5%; IQR, 54.5%-76.4%) for ventricular shunt procedures. Overall, ED length of stay did not change, and hospitalization and 3-day ED revisit rates decreased during the study period. Conclusions and Relevance This study found that use of advanced imaging increased from 2009 to 2018. Although CT use decreased, this decrease was accompanied by a greater increase in the use of ultrasonography and MRI. There appears to be substantial variation in practice and a need to standardize imaging practices.
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Affiliation(s)
- Jennifer R. Marin
- Division of Pediatric Emergency Medicine, UPMC Children’s Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | | | - Matt Hall
- Children’s Hospital Association, Lenexa, Kansas
| | - Elizabeth R. Alpern
- Division of Emergency Medicine, Department of Pediatrics, Ann & Robert H. Lurie Children’s Hospital of Chicago, Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Paul L. Aronson
- Department of Pediatrics, Yale School of Medicine, New Haven, Connecticut,Department of Emergency Medicine, Yale School of Medicine, New Haven, Connecticut
| | - Pradip P. Chaudhari
- Division of Emergency and Transport Medicine, Children’s Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles
| | - Eyal Cohen
- Department of Pediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Ontario, Canada
| | - Stephen B. Freedman
- Alberta Children’s Hospital Research Institute, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada ,Sections of Pediatric Emergency Medicine and Gastroenterology, Department of Pediatrics, Alberta Children’s Hospital, University of Calgary, Calgary, Alberta, Canada
| | - Rustin B. Morse
- Department of Pediatrics, Nationwide Children’s Hospital, Columbus, Ohio
| | - Alon Peltz
- Department of Population Medicine, Harvard Medical School, Harvard Pilgrim Health Care Institute, Boston, Massachusetts
| | | | - Samir S. Shah
- Division of Hospital Medicine, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio,Division of Infectious Diseases, Department of Pediatrics, Cincinnati Children’s Hospital Medical Center, Cincinnati, Ohio
| | - Harold K. Simon
- Department of Pediatrics, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia,Department of Emergency Medicine, Emory University School of Medicine, Children’s Healthcare of Atlanta, Atlanta, Georgia
| | - Mark I. Neuman
- Division of Emergency Medicine, Boston Children’s Hospital, Harvard Medical School, Boston, Massachusetts
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Kwan C, Pusic M, Pecaric M, Weerdenburg K, Tessaro M, Boutis K. The Variable Journey in Learning to Interpret Pediatric Point-of-care Ultrasound Images: A Multicenter Prospective Cohort Study. AEM EDUCATION AND TRAINING 2020; 4:111-122. [PMID: 32313857 PMCID: PMC7163207 DOI: 10.1002/aet2.10375] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 06/17/2019] [Accepted: 06/20/2019] [Indexed: 06/01/2023]
Abstract
OBJECTIVES To complement bedside learning of point-of-care ultrasound (POCUS), we developed an online learning assessment platform for the visual interpretation component of this skill. This study examined the amount and rate of skill acquisition in POCUS image interpretation in a cohort of pediatric emergency medicine (PEM) physician learners. METHODS This was a multicenter prospective cohort study. PEM physicians learned POCUS using a computer-based image repository and learning assessment system that allowed participants to deliberately practice image interpretation of 400 images from four pediatric POCUS applications (soft tissue, lung, cardiac, and focused assessment sonography for trauma [FAST]). Participants completed at least one application (100 cases) over a 4-week period. RESULTS We enrolled 172 PEM physicians (114 attendings, 65 fellows). The increase in accuracy from the initial to final 25 cases was 11.6%, 9.8%, 7.4%, and 8.6% for soft tissue, lung, cardiac, and FAST, respectively. For all applications, the average learners (50th percentile) required 0 to 45, 25 to 97, 66 to 175, and 141 to 290 cases to reach 80, 85, 90, and 95% accuracy, respectively. The least efficient (95th percentile) learners required 60 to 288, 109 to 456, 160 to 666, and 243 to 1040 cases to reach these same accuracy benchmarks. Generally, the soft tissue application required participants to complete the least number of cases to reach a given proficiency level, while the cardiac application required the most. CONCLUSIONS Deliberate practice of pediatric POCUS image cases using an online learning and assessment platform may lead to skill improvement in POCUS image interpretation. Importantly, there was a highly variable rate of achievement across learners and applications. These data inform our understanding of POCUS image interpretation skill development and could complement bedside learning and performance assessments.
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Affiliation(s)
- Charisse Kwan
- From the Division of Pediatric Emergency MedicineDepartment of PediatricsHospital for Sick Children and University of TorontoTorontoOntarioCanada
| | - Martin Pusic
- Department of Emergency Medicine and Division of Learning AnalyticsNYU School of MedicineNew YorkNY
| | | | - Kirstin Weerdenburg
- Department of Emergency MedicineIWK Health Centre and Dalhousie UniversityHalifaxNova ScotiaCanada
| | - Mark Tessaro
- From the Division of Pediatric Emergency MedicineDepartment of PediatricsHospital for Sick Children and University of TorontoTorontoOntarioCanada
| | - Kathy Boutis
- From the Division of Pediatric Emergency MedicineDepartment of PediatricsHospital for Sick Children and University of TorontoTorontoOntarioCanada
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22
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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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Point-of-Care Ultrasound Could Streamline the Emergency Department Workflow of Clinically Nonspecific Intussusception. Pediatr Emerg Care 2020; 36:e90-e95. [PMID: 28926507 DOI: 10.1097/pec.0000000000001283] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate whether point-of-care ultrasound (POCUS) for intussusception screening streamlines the workflow of clinically nonspecific intussusception (CNI), an intussusception presenting with only 1 manifestation of the classic triad, and/or vomiting. METHODS We reviewed 274 consecutive children with intussusception, aged 6 years or younger, who visited a tertiary care hospital emergency department between May 2012 and April 2016. This period was dichotomized by May 2014 (the "PRE" and "POST" groups), starting point of implementation of the POCUS protocol for intussusception screening. All children with CNI who had positive results on or forwent POCUS underwent radiologist-performed ultrasound (US). We measured and compared emergency department length of stay (EDLOS), the sum of door-to-reduction and observation times, and the frequency of POCUS and positive US results between the 2 groups. RESULTS Of 160 children with CNI, 93 visited the emergency department since May 2014. The POST group showed a shorter median EDLOS (856 vs 630 minutes, P < 0.001), door-to-reduction time (137 vs 111 minutes, P = 0.002), and observation time (700 vs 532 minutes, P < 0.001). The POST group had a higher frequency of POCUS (12% vs 60%, P < 0.001) with positive US results (33% vs 59%, P < 0.001). The PRE group had a higher frequency of severe bowel edema (16% vs 1%, P < 0.001). No significant differences were found in the severity, recurrence, admission, and surgery. One child had a false-negative result on POCUS. CONCLUSIONS Point-of-care ultrasound could streamline the workflow of CNI via decrease in EDLOS and unnecessary referrals for US.
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Point-of-care ultrasound: Is it time to include it in the paediatric specialist training programme? An Pediatr (Barc) 2019. [DOI: 10.1016/j.anpede.2019.06.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
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Mayordomo-Colunga J, González-Cortés R, Bravo MC, Martínez-Mas R, Vázquez-Martínez JL, Renter-Valdovinos L, Conlon TW, Nishisaki A, Cabañas F, Bilbao-Sustacha JÁ, Oulego-Erroz I. [Point-of-care ultrasound: Is it time to include it in the paediatric specialist training program?]. An Pediatr (Barc) 2019; 91:206.e1-206.e13. [PMID: 31395389 DOI: 10.1016/j.anpedi.2019.06.012] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 06/22/2019] [Indexed: 11/16/2022] Open
Abstract
Point-of-care ultrasound (POCUS) has become an essential tool for clinical practice in recent years. It should be considered as an extension of the standard physical examination, which complements and enriches it without substituting it. POCUS enables the physician to answer specific clinical questions about the diagnosis, to understand better the pathophysiological context, to orientate the treatment, and to perform invasive procedures more safely. Despite its current use in many centres, and in most paediatric sub-specialties, there are currently no specific recommendations addressing educational aims in the different training areas, as well as methodology practice and the certification process in paediatrics. These ingredients are essential for POCUS implementation in daily practice, with a quality guarantee in terms of efficiency and safety. Several POCUS experts in different paediatric medicine environments performed a non-systematic review addressing the main paediatric POCUS applications in paediatrics. The lack of educational programs in POCUS in Spain is also discussed, and the experience in the United States of America in this topic is provided. Considering the current situation of POCUS in paediatrics, we strongly believe that it is urgent to establish evidence-based recommendations for POCUS training that should be the base to develop educational programs and to include POCUS in the paediatric residency training.
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Affiliation(s)
- Juan Mayordomo-Colunga
- Sección de Cuidados Intensivos Pediátricos, Área de Gestión Clínica de Pediatría, Hospital Universitario Central de Asturias, Oviedo, España; CIBER-Enfermedades Respiratorias, Instituto de Salud Carlos III, Madrid, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España; Instituto de Investigación Sanitaria del Principado de Asturias, Oviedo, España
| | - Rafael González-Cortés
- Unidad de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Red de Salud Materno Infantil y del Desarrollo. RETICS financiada por el ISCIII (Ref. 16/0022), Madrid, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España
| | - María Carmen Bravo
- Departamento de Neonatología, Hospital Universitario La Paz, Madrid, España
| | - Roser Martínez-Mas
- Servicio de Urgencias de Pediatría, Hospital Universitario Cruces, Barakaldo, Vizcaya, España; Grupo de Trabajo de Ecografía a Pie de Cama de la Sociedad Española de Urgencias Pediátricas (SEUP), España
| | - José Luis Vázquez-Martínez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Ramón y Cajal, Madrid, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España
| | - Luis Renter-Valdovinos
- Unidad de Cuidados Intensivos Pediátricos, Servicio de Medicina Pediátrica, Parc Taulí, Hospital Universitario, Sabadell, Barcelona, España; Unidad de Transporte Pediátrico, Hospital Universitario Vall d'Hebron, Universitat Autònoma de Barcelona, Barcelona, España; Base SEM-Pediátrico BP61, Sistema de Emergencias Médicas de Catalunya (SEM), Barcelona, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España
| | - Thomas W Conlon
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Filadelfia, Pensilvania, Estados Unidos
| | - Akira Nishisaki
- Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Filadelfia, Pensilvania, Estados Unidos
| | - Fernando Cabañas
- Departamento de Pediatría y Neonatología, Hospital Universitario Quironsalud, Madrid, España; Fundación de Investigación Biomédica, Hospital Universitario La Paz, Madrid, España
| | - José Ángel Bilbao-Sustacha
- Área Básica de Salud de Riudoms, Riudoms, Tarragona, España; Grupo de Trabajo de Ecografía Clínica de la Asociación Española de Pediatría de Atención Primaria (AEPAP), España
| | - Ignacio Oulego-Erroz
- Cardiología Infantil, Unidad de Cuidados Intensivos Pediátricos, Servicio de Pediatría, Complejo Asistencial Universitario de León, León, España; IBIOMED, Instituto de Biomedicina de León, León, España; Grupo de Trabajo de Ecografía de la Sociedad Española de Cuidados Intensivos Pediátricos (SECIP), España.
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Comparing ultrasonography with plain radiography in the diagnosis of paediatric long-bone fractures. INTERNATIONAL ORTHOPAEDICS 2018; 43:1143-1153. [DOI: 10.1007/s00264-018-4133-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/27/2018] [Accepted: 08/23/2018] [Indexed: 11/26/2022]
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Abstract
PURPOSE OF REVIEW The diagnostic capability, efficiency and versatility of point-of-care ultrasound (POCUS) have enabled its use in paediatric emergency medicine (PEM) and paediatric critical care (PICU). This review highlights the current applications of POCUS for the critically ill child across PEM and PICU to identify areas of progress and standardized practice and to elucidate areas for future research. RECENT FINDINGS POCUS technology continues to evolve and advance bedside clinical care for critically ill children, with ongoing research extending its use for an array of clinical scenarios, including respiratory distress, trauma and dehydration. Rapidly evolving and upcoming applications include diagnosis of pneumonia and acute chest syndrome, identification of intra-abdominal injury via contrast-enhancement, guidance of resuscitation, monitoring of increased intracranial pressure and procedural guidance. SUMMARY POCUS is an effective and burgeoning method for both rapid diagnostics and guidance for interventions and procedures. It has clinical application for a variety of conditions that span PEM and PICU settings. Formal POCUS training is needed to standardize and expand use of this valuable technology by PICU and PEM providers alike.
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Principi N, Esposito A, Giannitto C, Esposito S. Lung ultrasonography to diagnose community-acquired pneumonia in children. BMC Pulm Med 2017; 17:212. [PMID: 29258484 PMCID: PMC5735901 DOI: 10.1186/s12890-017-0561-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Accepted: 12/08/2017] [Indexed: 12/26/2022] Open
Abstract
Background Early diagnosis of community-acquired pneumonia (CAP) is essential to reduce the total burden of this disease. Traditionally, chest radiography (CR) is used to identify true CAP. However, CR is not a perfect diagnostic test for CAP. The use of lung ultrasonography (LUS) has been suggested as an alternative to overcome the problems associated with CR and increase the feasibility and accuracy of CAP diagnosis. LUS has largely been used for the diagnosis of several lung problems, including CAP, in adult patients with satisfactory results. Experience with LUS in children has grown over recent years. The main aim of this paper is to discuss the advantages and limits of LUS in the diagnosis of paediatric CAP. Discussion The presence of a consolidation pattern during LUS may represent pneumonia or atelectasis, although this conclusion is operator dependent. An overall agreement between LUS and CR was observed in most of the studies that were examined. In most reports where a disagreement between the two methods was found, CR was not able to identify the cases that were correctly diagnosed by LUS, particularly when CR was performed only with postero-anterior/antero-posterior projection and consolidation was observed in lung areas that are poorly visualized by CR. However, the lack of standardized LUS methods is problematic. Finally, the real advantage of LUS for the diagnosis of CAP in children remains unclear. Summary LUS is an interesting diagnostic modality that appears a useful first imaging test in children with suspected CAP. However, the methods used to perform LUS in children are not precisely standardized, and the diagnosis of interstitial CAP is inaccurate. Further studies are needed before LUS can be routinely used in everyday paediatric practice.
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Affiliation(s)
- Nicola Principi
- Department of Pathophysiology and Transplantation, Università degli Studi di Milano, Milan, Italy
| | - Andrea Esposito
- Unit of Radiology, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan, Italy
| | | | - Susanna Esposito
- Paediatric Clinic, Department of Surgical and Biomedical Sciences, Università degli Studi di Perugia, Piazza Menghini 1, 06129, Perugia, Italy.
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Alzayedi AS, Azizalrahman AA, AlMadi HA, Althekair AM, Blaivas M, Karakitsos D. Use and Education of Point-of-Care Ultrasound in Pediatric Emergency Medicine in Saudi Arabia. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:2219-2225. [PMID: 28569379 DOI: 10.1002/jum.14254] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2016] [Revised: 01/18/2017] [Accepted: 02/02/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVES Point-of-care ultrasound (US) is an emerging tool used by pediatric emergency physicians in the last decade. Currently in the Middle East, point-of-care US use and education are at an early stage, with no designed curriculum or guidelines for its implementation in pediatric emergency medicine (EM). The objective of this article is to describe the clinical and educational uses of point-of-care US among certified pediatric EM physicians. METHODS A 19-question survey was sent to all certified pediatric emergency physicians and fellows in pediatric emergency fellowships in Saudi Arabia in February 2016. Reminders were sent weekly for 4 weeks. RESULTS The response rate was 84 of 88 (95%). Fifty-one of 84 (61%) reported using point-of-care US. Focused assessment with sonography for trauma was the most frequent use of point-of-care US (37%), followed by procedures (19%). The most common barrier for not using point-of-care US was limited training (86%). The most preferred tool for point-of-care US teaching was courses by EM physicians. Currently, there is no specific curriculum designed for pediatric EM in the Middle East. CONCLUSIONS Despite the multiple applications of point-of-care US in pediatric EM, its use is still limited. Formal point-of-care US training with bedside sessions and courses was the mort preferred method of education. A designed curriculum needs to be implemented in pediatric emergency fellowships in Saudi Arabia.
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Affiliation(s)
- Abdullah Saad Alzayedi
- King Saud Medical City, Children's Hospital, Riyadh, Saudi Arabia
- King Fahad Medical City, Children's Hospital, Riyadh, Saudi Arabia
| | | | - Hamad A AlMadi
- King Saud Medical City, Children's Hospital, Riyadh, Saudi Arabia
| | | | - Michael Blaivas
- University of South Carolina school of Medicine, Colombia, South Carolina, USA
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Gold DL, Marin JR, Haritos D, Melissa Skaugset L, Kline JM, Stanley RM, Way DP, Bahner DP. Pediatric Emergency Medicine Physicians' Use of Point-of-care Ultrasound and Barriers to Implementation: A Regional Pilot Study. AEM EDUCATION AND TRAINING 2017; 1:325-333. [PMID: 30051051 PMCID: PMC6001823 DOI: 10.1002/aet2.10049] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/09/2017] [Revised: 06/16/2017] [Accepted: 06/20/2017] [Indexed: 05/28/2023]
Abstract
OBJECTIVES Point-of-care ultrasound (POCUS) has been identified as a critical skill for pediatric emergency medicine (PEM) physicians. The purpose of this study was to profile the current status of PEM POCUS in pediatric emergency departments (EDs). METHODS An electronic survey was distributed to PEM fellows and attending physicians at four major pediatric academic health centers. The 24-item questionnaire covered professional demographics, POCUS experience and proficiency, and barriers to the use of POCUS in pediatric EDs. We used descriptive and inferential statistics to profile respondent's PEM POCUS experience and proficiency and Rasch analysis to evaluate barriers to implementation. RESULTS Our return rate was 92.8% (128/138). Respondents were attending physicians (68%) and fellows (28%). Most completed pediatric residencies prior to PEM fellowship (83.6%). Almost all had some form of ultrasound education (113/128, 88.3%). Approximately half (46.9%) completed a formal ultrasound curriculum. More than half (53.2%) said their ultrasound education was pediatric-specific. Most participants (67%) rated their POCUS proficiency low (Levels 1-2), while rating proficiency in other professional competencies (procedures 52%, emergency stabilization 70%) high (Levels 4-5). There were statistically significant differences in POCUS proficiency between those with formal versus informal ultrasound education (p < 0.001) and those from pediatric versus emergency medicine residencies (p < 0.05). Participants identified both personal barriers discomfort with POCUS skills (76.7%), insufficient educational time to learn POCUS (65%), and negative impact of POCUS on efficiency (58.5%)-and institutional barriers to the use of ultrasound-consultants will not use ultrasound findings from the ED (60%); insufficient mentoring (64.7%), and POCUS not being a departmental priority (57%). CONCLUSIONS While POCUS utilization continues to grow in PEM, significant barriers to full implementation still persist. One significant barrier relates to the need for dedicated time to learn and practice POCUS to achieve sufficient levels of proficiency for use in practice.
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Affiliation(s)
- Delia L. Gold
- Department of Emergency MedicineNationwide Children's Hospital and The Ohio State University College of MedicineColumbusOH
| | - Jennifer R. Marin
- Departments of Pediatrics and Emergency MedicineChildren's Hospital of Pittsburgh and University of Pittsburgh School of MedicinePittsburghPA
| | - Demetris Haritos
- Department of Emergency Medicine and PediatricsChildren's Hospital of Michigan and Wayne State University School of MedicineDetroitMI
| | - L. Melissa Skaugset
- Department of Emergency MedicineC. S. Mott Children's Hospital and University of Michigan School of MedicineAnn ArborMI
- Present address:
Mary Bridge Children's Hospital in TacomaWA
| | | | - Rachel M. Stanley
- Department of Emergency MedicineNationwide Children's Hospital and The Ohio State University College of MedicineColumbusOH
| | - David P. Way
- Department of Emergency MedicineThe Ohio State University College of MedicineColumbusOH
| | - David P. Bahner
- Department of Emergency MedicineThe Ohio State University College of MedicineColumbusOH
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Brenkert TE, Adams C, Vieira RL, Rempell RG. Peritoneal fluid localization on FAST examination in the pediatric trauma patient. Am J Emerg Med 2017; 35:1497-1499. [DOI: 10.1016/j.ajem.2017.04.025] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2017] [Accepted: 04/13/2017] [Indexed: 11/28/2022] Open
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González Cortés R, Renter Valdovinos L, Coca Pérez A, Vázquez Martínez JL. Point-of-care ultrasound in Spanish paediatric intensive care units. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2017. [DOI: 10.1016/j.anpede.2016.06.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Jaeel P, Sheth M, Nguyen J. Ultrasonography for endotracheal tube position in infants and children. Eur J Pediatr 2017; 176:293-300. [PMID: 28091777 DOI: 10.1007/s00431-017-2848-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2016] [Revised: 12/21/2016] [Accepted: 01/02/2017] [Indexed: 01/19/2023]
Abstract
UNLABELLED Ultrasonography (US) has been shown to be effective for verifying endotracheal tube (ETT) position in adults but has been less studied in infants and children. We review the literature regarding US for ETT positioning in the pediatric population. A literature search was conducted using the Ovid and MEDLINE databases with search terms regarding US relating to ETT intubation and positioning in infants and children. Most studies in neonates and infants used the midsagittal suprasternal view. Studies reported >80% visualization of the ETT tip by US, and US interpretation of the ETT position correlated with the XR position in 73-100% of cases. Studies of older children used the suprasternal views, substernal views, and mid-axillary intercostal views. US appears comparable to XR and capnography in determining ETT position in this population. CONCLUSION US for ETT verification appears to be well tolerated in infants and children and may augment determination of proper ETT position in combination with other ETT verification modalities. Further studies are needed regarding technique and training. What is Known: • Point-of-care ultrasonography is realizing increased availability and use in several pediatric specialties. • Ultrasonography has been shown to be effective for verifying ETT position in adults but have been less studied in infants and children. What is New: • Ultrasonography for endotracheal tube verification appears to be well tolerated in infants and children. • Ultrasonography may augment determination of proper endotracheal tube position in combination with other verification modalities such as radiography and capnography in the pediatric population.
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Affiliation(s)
- Pooja Jaeel
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Mansi Sheth
- Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - Jimmy Nguyen
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA. .,Center for Fetal and Neonatal Medicine, Division of Neonatal-Perinatal Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, 1200 N. State Street-IRD-820, Los Angeles, CA, 90033, USA.
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Augenstein JA, Yoshida H, Lo MD, Solari P. A Readily Available, Inexpensive, and Reusable Simulation Model for Teaching Ultrasound-Guided Abscess Identification and Drainage. J Emerg Med 2016; 50:462-5. [PMID: 26899194 DOI: 10.1016/j.jemermed.2015.12.020] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2015] [Revised: 12/16/2015] [Accepted: 12/21/2015] [Indexed: 11/26/2022]
Abstract
BACKGROUND The use of point-of-care ultrasonography as a noninvasive diagnostic tool for soft tissue infections has been shown to be superior to clinical judgment alone in determining the presence or absence of an occult abscess. As ultrasound-guided procedures become standard of care, there is an increasing demand to develop better and inexpensive simulation models to educate trainees. To date, there are no low-cost models for abscess simulation that can be constructed with minimal preparation time, be reused, and withstand multiple procedural attempts. OBJECTIVE To create an inexpensive, readily available, and reusable homemade ultrasound phantom that simulates a superficial soft tissue abscess and can be easily constructed. DISCUSSION We experimented with precooked polenta to create a model that would appear similar to human soft tissue under ultrasound examination. Paintballs were embedded in the polenta and evaluated at different depths until a sonographically satisfactory phantom abscess model was obtained. The use of a precooked commercial polenta phantom and commercial paintballs required minimal preparation and closely replicated a superficial soft tissue abscess on ultrasonographic examination. Various paintball brands and sizes were evaluated to confirm ease of reproducibility. The polenta can be reshaped easily and the model may be punctured or incised multiple times. CONCLUSION A homemade high-fidelity simulation phantom that simulates an abscess in superficial soft tissue can be made inexpensively in <5 min and reused for numerous trainees. This model allows for training for procedures such as ultrasound-guided abscess drainage.
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Affiliation(s)
- Julie A Augenstein
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Hiromi Yoshida
- Department of Pediatrics, University of Washington School of Medicine, Seattle, Washington
| | - Mark D Lo
- Department of Emergency Medicine, Seattle Children's Hospital, Seattle, Washington
| | - Patrick Solari
- Department of Emergency Medicine, Seattle Children's Hospital, Seattle, Washington; Department of Emergency Medicine, University of Washington School of Medicine, Seattle, Washington
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Nguyen J, Amirnovin R, Ramanathan R, Noori S. The state of point-of-care ultrasonography use and training in neonatal-perinatal medicine and pediatric critical care medicine fellowship programs. J Perinatol 2016; 36:972-976. [PMID: 27513327 DOI: 10.1038/jp.2016.126] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2016] [Revised: 07/01/2016] [Accepted: 07/06/2016] [Indexed: 11/09/2022]
Abstract
OBJECTIVE The current state of point-of-care ultrasonography (POCUS) use and education in neonatal-perinatal medicine (NPM) and pediatric critical care medicine (PCCM) is unknown. Our aim was to quantify POCUS use, training and perceptions regarding education and barriers among the United States NPM and PCCM fellowship programs. STUDY DESIGN A 14-question survey was emailed to the fellowship directors of all the United States NPM and PCCM fellowship programs. RESULTS The response rate was 55% (52/95) and 59% (39/66) for NPM and PCCM programs, respectively. Over 90% of respondents in both groups believe that fellows and attendings should receive POCUS training. PCCM programs, compared with NPM, had greater access to POCUS machines (97% vs 63%, P<0.001), and more often used POCUS for diagnoses and management (76% vs 29%, P<0.001) and procedural guidance (95% vs 37%, P<0.001). The most common indications were cardiac/hemodynamics, pulmonary pathology and vascular access in both specialties. PCCM reported more training to fellows (90% vs 29%, P<0.001). Both group perceived lack of time to learn, lack of equipment/funds, liability concerns, lack of personnel to train physicians and cardiology/radiology resistance as significant barriers to POCUS implementation. CONCLUSIONS Both NPM and PCCM fellowship programs believe in the benefits of POCUS and that their physicians should receive the necessary training. Compared with PCCM, NPM fellowships programs have less access to POCUS machines and less frequently use POCUS and train their fellows and attendings. There remain significant barriers to utilization of POCUS, especially in NPM.
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Affiliation(s)
- J Nguyen
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R Amirnovin
- Anesthesiology Critical Care Medicine, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - R Ramanathan
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
| | - S Noori
- Division of Neonatal-Perinatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,Center for Fetal and Neonatal Medicine, Department of Pediatrics, Children's Hospital Los Angeles, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA.,LAC+USC Medical Center, Keck School of Medicine, University of Southern California, Los Angeles, CA, USA
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Analysis of lawsuits related to point-of-care ultrasonography in neonatology and pediatric subspecialties. J Perinatol 2016; 36:784-6. [PMID: 27078203 DOI: 10.1038/jp.2016.66] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/24/2016] [Revised: 03/14/2016] [Accepted: 03/17/2016] [Indexed: 12/16/2022]
Abstract
OBJECTIVE Point-of-care ultrasonography (POCUS) is becoming increasingly available for neonatologists and pediatric subspecialists (PSS); however, concerns over potential litigation from possible missed diagnoses or incorrect management have been documented. This study aims to define the extent and quality of lawsuits filed against neonatologists and PSS related to POCUS. STUDY DESIGN We conducted a retrospective study of all United States reported state and federal cases in the Westlaw database from January 1990 through October 2015. Cases were reviewed and included if either a neonatologist or PSS were accused of misconduct or the interpretation or failure to perform an ultrasound/echocardiogram was discussed. Descriptive statistics were used to evaluate the data. RESULTS Our search criteria returned 468 results; 2 cases were determined to be relevant to the study objective. The two cases alleged a failure to perform a diagnostic test and implicated POCUS as an option. There were no cases of neonatologists and PSS being sued for POCUS performance or interpretation. CONCLUSION This study of a major legal database suggests that POCUS use and interpretation is not a significant cause of lawsuits against neonatologists and PSS.
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González Cortés R, Renter Valdovinos L, Coca Pérez A, Vázquez Martínez JL. [Point-of-care ultrasound in Spanish paediatric intensive care units]. An Pediatr (Barc) 2016; 86:344-349. [PMID: 27436571 DOI: 10.1016/j.anpedi.2016.06.009] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Accepted: 06/15/2016] [Indexed: 01/06/2023] Open
Abstract
INTRODUCTION Point-of-care (bedside) ultrasound is being increasingly used by paediatricians who treat critically ill children. The aim of this study is to describe its availability, use, and specific training in Paediatric Intensive Care Units in Spain. MATERIAL AND METHODS A descriptive, cross-sectional, multicentre study was performed using an online survey. RESULTS Of a total of 51 PICUs identified in our country, 64.7% responded to the survey. Just over half (53.1%) have their own ultrasound machine, 25% share it, with other units with the usual location in the PICU, and 21.9% share it, but it is usually located outside the PICU. Ultrasound machine availability was not related to size, care complexity, or number PICU admissions. The ultrasound was used daily in 35% of the units, and was associated with location of the machine in the PICU (P=.026), the existence of a transplant program (P=.009), availability of ECMO (P=.006), and number of admissions (P=.015). 45.5% of PICUs has less than 50% of the medical staff specifically trained in bedside ultrasound, and 18.2% have all their medical staff trained. The presence of more than 50% of medical staff trained was associated with a higher rate of daily use (P=.033), and with specific use to evaluate cardiac function (P=.033), intravascular volume estimation (P=.004), or the presence of intra-abdominal collections (P=.021). CONCLUSIONS Bedside ultrasound is frequently available in Spanish PICUs. Specific training is still variable, but it should serve to enhance its implementation.
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Affiliation(s)
- Rafael González Cortés
- Servicio de Cuidados Intensivos Pediátricos, Hospital General Universitario Gregorio Marañón, Madrid, España; Instituto de investigación Sanitaria Gregorio Marañón, RETICS financiada por el PN I+D+I 2008-2011, ISCIII - Subdirección General de Evaluación y Fomento de la Investigación y el Fondo Europeo de Desarrollo Regional (FEDER), ref. RD12/0026; Red de Salud Materno Infantil y Desarrollo, Madrid, España.
| | - Luis Renter Valdovinos
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Parc Taulí, Sabadell, Barcelona, España
| | - Ana Coca Pérez
- Unidad de Cuidados Intensivos Pediátricos, Hospital Universitario Ramón y Cajal, Madrid, España
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Abstract
This article is the third in a 7-part series that aims to comprehensively describe the current state and future directions of pediatric emergency medicine fellowship training from the essential requirements to considerations for successfully administering and managing a program to the careers that may be anticipated upon program completion. This article focuses on the clinical aspects of fellowship training including the impact of the clinical environment, modalities for teaching and evaluation, and threats and opportunities in clinical education.
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Emergency point-of-care ultrasound in Canadian pediatric emergency fellowship programs: current integration and future directions. CAN J EMERG MED 2016; 18:469-474. [PMID: 27021289 DOI: 10.1017/cem.2016.20] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND Adult and pediatric emergency physicians have been using point-of-care ultrasound (POCUS) for many years. It is a fast, usually painless, noninvasive diagnostic tool that does not expose the patient to radiation. Information about its current implementation in pediatric emergency medicine (PEM) fellowship programs in Canada is lacking. OBJECTIVE The main goal of our study was to investigate current integration and future direction of POCUS training in Canadian PEM programs. METHODS The study consisted of two surveys designed for fellows and program directors of all Canadian PEM fellowship programs. The major aspects of the survey were 1) to describe current training in POCUS in fellowship programs, 2) to compare the kind of training that programs offer with what fellows actually receive, and 3) a needs assessment by fellows and program directors for future POCUS training programs. Surveys were sent to program directors and passed on to their fellows. RESULTS Ninety percent of fellowship program directors as well as 70% (42/60) of fellows responded to the survey. A formal POCUS curriculum exists in five of the nine PEM programs included in this study. Three programs offer specific pediatric POCUS training. The main application is the FAST (focused assessment with sonography for trauma) exam. CONCLUSION There is a wide variation in POCUS content and delivery across PEM fellowship programs, as well as differences in perceptions of current training and of needs by fellows and program directors. However, given that both groups feel POCUS is very important and essential for PEM training, the opportunity exists to develop a standardized curriculum across Canada.
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Point-of-Care Ultrasonography for the Diagnosis of Pediatric Soft Tissue Infection. J Pediatr 2016; 169:122-7.e1. [PMID: 26563535 DOI: 10.1016/j.jpeds.2015.10.026] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/04/2015] [Revised: 09/18/2015] [Accepted: 10/07/2015] [Indexed: 11/21/2022]
Abstract
OBJECTIVES To determine the test characteristics of point-of-care ultrasonography for the identification of a drainable abscess and to compare the test characteristics of ultrasonography with physical examination. In addition, we sought to measure the extent to which ultrasonography impacts clinical management of children with skin and soft tissue infections (SSTIs). STUDY DESIGN We performed a prospective study of children with SSTIs evaluated in a pediatric emergency department. Treating physicians recorded their initial impression of whether a drainable abscess was present based on physical examination. Another physician, blinded to the treating physician's assessment, performed an ultrasound study and conveyed their interpretation and recommendations to the treating physician. Any management change was recorded. An abscess was defined as a lesion from which purulent fluid was expressed during a drainage procedure in the emergency department or during the 2- to 5-day follow-up period. We defined a change in management as correct when the ultrasound diagnosis was discordant from physical examination and matched the ultimate lesion classification. RESULTS Of 151 SSTIs evaluated among 148 patients, the sensitivity and specificity of point-of-care ultrasonography for the presence of abscess were 96% (95% CI 90%-99%) and 87% (74%-95%), respectively. The sensitivity and specificity of physical examination for the presence of abscess were 84% (75%-90%) and 60% (44%-73%), respectively. For every 4 ultrasound examinations performed, there was 1 correct change in management. CONCLUSIONS Point-of-care ultrasonography demonstrates excellent test characteristics for the identification of skin abscess and has superior test characteristics compared with physical examination alone.
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A Review of Pediatric Ultrasound-Guided Peripheral Intravenous Access. CLINICAL PEDIATRIC EMERGENCY MEDICINE 2015. [DOI: 10.1016/j.cpem.2015.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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D’Amico BM. Point-Of-Care Ultrasound in Pediatric Emergency Medicine: What Do Fellows Need to Know? CLINICAL PEDIATRIC EMERGENCY MEDICINE 2015. [DOI: 10.1016/j.cpem.2015.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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Abstract
The use of point-of-care ultrasound in the pediatric emergency department is evolving beyond conventional applications as users become more expert with the technology. In this case series, we describe the potential utility of recognizing abnormal anatomy to impact care in the context of possible cancer in pediatric patients. We describe 4 patients with Langerhans histiocytosis, neuroblastoma, Wilms tumor, and rhabdomyosarcoma, in which point-of-care ultrasound was used to facilitate the diagnoses.
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Abstract
April 2015 marks the publication of the first national guideline regarding point-of-care ultrasound by pediatric emergency medicine physicians. The joint statement by the American Academy of Pediatrics, Society for Academic Emergency Medicine, American College of Emergency Physicians, and World Interactive Network Focused on Critical Ultrasound provides a framework on which pediatric emergency physicians can develop the necessary skills to use point-of-care ultrasound effectively and responsibly.
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Marin JR, Lewiss RE. Point-of-care Ultrasonography by Pediatric Emergency Medicine Physicians. Acad Emerg Med 2015; 22:623-4. [PMID: 25899848 DOI: 10.1111/acem.12659] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2015] [Accepted: 02/02/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Jennifer R. Marin
- Department of Pediatrics; University of Pittsburgh School of Medicine; Pittsburgh PA
- Department of Emergency Medicine; University of Pittsburgh School of Medicine; Pittsburgh PA
| | - Resa E. Lewiss
- Department of Emergency Medicine University of Colorado School of Medicine; Denver CO
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Rosenfield D, Kwan C, Fischer J. Point-of-care ultrasound: An emerging technology in Canadian paediatrics. Paediatr Child Health 2015; 20:67-8. [PMID: 25838776 DOI: 10.1093/pch/20.2.67] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/12/2015] [Indexed: 11/13/2022] Open
Affiliation(s)
| | - Charisse Kwan
- Deparment of Paediatrics, University of Toronto, Toronto, Ontario ; Department of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario
| | - Jason Fischer
- Deparment of Paediatrics, University of Toronto, Toronto, Ontario ; Department of Emergency Medicine, The Hospital for Sick Children, Toronto, Ontario
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Abstract
Emergency physicians have used point-of-care ultrasonography since the 1990 s. Pediatric emergency medicine physicians have more recently adopted this technology. Point-of-care ultrasonography is used for various scenarios, particularly the evaluation of soft tissue infections or blunt abdominal trauma and procedural guidance. To date, there are no published statements from national organizations specifically for pediatric emergency physicians describing the incorporation of point-of-care ultrasonography into their practice. This document outlines how pediatric emergency departments may establish a formal point-of-care ultrasonography program. This task includes appointing leaders with expertise in point-of-care ultrasonography, effectively training and credentialing physicians in the department, and providing ongoing quality assurance reviews.
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Abstract
PURPOSE OF REVIEW Point-of-care ultrasound (POCUS) has become an integral part of emergency medicine practice. Research evaluating POCUS in the care of pediatric patients has improved the understanding of its potential role in clinical care. RECENT FINDINGS Recent work has investigated the ability of pediatric emergency medicine (PEM) physicians to perform a wide array of diagnostic and procedural applications in POCUS ultrasound. Studies have demonstrated that PEM providers are able to identify an array of diseases, including intussusception, pyloric stenosis and appendicitis. Novel applications of ultrasound, such as a cardiac evaluation in the acutely ill patient or identification of skull fractures in the assessment of a patient with head injury, have shown excellent promise in recent studies. These novel applications have the potential to reshape pediatric diagnostic algorithms. SUMMARY Key applications in PEM have been investigated in the recent publications. Further exploration of the ability to integrate ultrasound into routine practice will require larger-scale studies and continued growth of education in the field. The use of ultrasound in clinical practice has the potential to improve safety and efficiency of care in the pediatric emergency department.
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Vieira RL, Hsu D, Nagler J, Chen L, Gallagher R, Levy JA. Pediatric emergency medicine fellow training in ultrasound: consensus educational guidelines. Acad Emerg Med 2013; 20:300-6. [PMID: 23517263 DOI: 10.1111/acem.12087] [Citation(s) in RCA: 73] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2012] [Revised: 09/01/2012] [Accepted: 09/26/2012] [Indexed: 11/29/2022]
Abstract
The importance of point-of-care emergency ultrasound (EUS) to the practice of emergency medicine (EM) is well established, and mounting research continues to demonstrate how EUS can benefit pediatric emergency department (ED) patients. As members of the EM community, pediatric EM (PEM) physicians should understand the potential value of EUS and seek opportunities to incorporate EUS into their daily practice. Currently, EUS education and training is at an early developmental stage for PEM fellows and varies greatly between programs. The goal of this article is to provide consensus education guidelines and to describe a sample curriculum that can be used by PEM fellowship programs when developing or revising their US training curricula. The authors recognize that programs may be at different stages of EUS development and will consequently need to tailor curricula to individual institutional needs and capabilities. This guideline was developed through a collaborative process between EUS educators and members of the American Academy of Pediatrics Section of EM Fellowship Directors Subcommittee. The guideline includes the following topics: important considerations regarding EUS in PEM, PEM US program framework, PEM US curriculum, PEM US education program, and competency assessment.
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Affiliation(s)
- Rebecca L. Vieira
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
- Department of Pediatrics; Harvard Medical School; Boston MA
| | - Deborah Hsu
- Section of Emergency Medicine; Texas Children's Hospital; Houston TX
- Department of Pediatrics; Baylor College of Medicine; Houston TX
| | - Joshua Nagler
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
- Department of Pediatrics; Harvard Medical School; Boston MA
| | - Lei Chen
- Section of Emergency Medicine; Yale University School of Medicine; New Haven CT
| | - Rachel Gallagher
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
- Department of Pediatrics; Harvard Medical School; Boston MA
| | - Jason A. Levy
- Division of Emergency Medicine; Boston Children's Hospital; Boston MA
- Department of Pediatrics; Harvard Medical School; Boston MA
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