88 - Cardiac Point-of-Care Ultrasound in Children with Preexisting Cardiac Conditions

Poster Number: 88
Publication Number: 88.303

Robert M. Hoffmann, Boston Children's Hospital, BOSTON, MA, United States; Jeffrey T. Neal, Boston Children's Hospital, Chestnut Hill, MA, United States; Piyawat Arichai, Children's National Hospital, Washington, DC, United States; Cynthia Gravel, Boston Children's Hospital, Needham, MA, United States; Mark I. Neuman, Boston Children's Hospital, Boston, MA, United States; Jason Levy, Boston Children's Hospital, Boston, MA, United States; Andrew F. Miller, Boston Children's Hospital, Brookline, MA, United States

Background: Cardiac point-of-care ultrasound (POCUS) is widely accepted by the American Academy of Pediatrics and is an integral part of the curriculum of pediatric emergency medicine (PEM) trainees. There is limited data on how cardiac POCUS performs in patients with pre-existing cardiac disease.

Objective: To assess diagnostic performance of cardiac POCUS performed by PEM physicians compared to expert sonographer review and cardiologist-performed echocardiogram in children with pre-existing cardiac disease.

Design/Methods: Among a convenience sample of children with pre-existing cardiac disease presenting to a tertiary care pediatric ED, we evaluated the use of cardiac POCUS by PEM physicians. We assessed the indication for POCUS, patient characteristics, and the test characteristics of POCUS. The test characteristics of the sonographer interpretation for the assessment of both pericardial effusion as well as global cardiac systolic dysfunction were compared to expert POCUS review by PEM physicians with POCUS fellowship training or Registered Diagnostic Medical Sonographer certification. Interpretation was also compared to cardiologist-performed echocardiography for the subset of children in in whom this was performed.

Results: A total of 114 children with pre-existing cardiac disease underwent cardiac POCUS examinations between July 2015 and December 2017. The most common prior cardiac conditions were congenital (structural cardiac defects) (64%), acquired (18%), and arrhythmias (10%). Cardiac POCUS was most frequently obtained due to chest pain (55%), dyspnea (18%), tachycardia (17%) and syncope (10%). Real time cardiac POCUS interpretation compared to expert review had a sensitivity of 100% for both pericardial effusion and global cardiac systolic dysfunction. Specificity of real time cardiac POCUS was 97.6% for pericardial effusion and 98.9% for global cardiac systolic dysfunction. Test characteristics of real time cardiac POCUS compared to expert POCUS review and cardiologist-performed echocardiography are demonstrated in Table 1.Conclusion(s): Cardiac POCUS demonstrates high sensitivity and specificity in diagnosing pericardial effusion and global cardiac systolic dysfunction in children with pre-existing cardiac conditions. These findings support the use of cardiac POCUS in children with known cardiac conditions presenting to the ED.
Table 1Test characteristics of cardiac POCUS in detection of pericardial effusion and systolic dysfunction in patients with a pre-existing cardiac condition.