| Popis: |
The objective of this study was to evaluate the implementation of a focused cardiac ultrasound (FoCUS) protocol in a pediatric emergency department (PED). Methods We conducted a cross-sectional, observational, quality improvement project in a PED of an urban tertiary care Vinnitsa region children hospital. A FoCUS protocol was collaboratively developed by pediatric intensive care and pediatric emergency medicine. This included a reference document with definitions, indications, image acquisition guidelines, and interpretation expectations. We measured physician-emergency pediatric doctors performance against pediatric cardiologist interpretation of stored cine clips as our reference standard. Focused cardiac ultrasound interpretation was dichotomized for the presence or absence of pericardial effusion, depressed left ventricular function, and chamber size abnormalities. Results 243 FoCUSs were performed by 5 different emergency doctors from January 218 to December 2019. The prevalence of FoCUS abnormalities was 19.4%. For pericardial effusion, sensitivity was 99,2% (95% confidence interval [CI], 48%–100%) and specificity was 94% (95% CI, 90–100%). For depressed function, sensitivity was 99,4% (95% CI, 56%–100%) and specificity was 98% (95% CI, 94%–100%). For chamber size abnormalities, sensitivity was 97% (95% CI, 50%–100%) and specificity was 95% (95% CI, 88%–98%). The median number of monthly FoCUS increased from 3 (preprotocol) to 7 (postprotocol), and the median rate of adequate studies increased from 0% to 55%. Conclusions We report the collaborative development and successful implementation of a PED FoCUS protocol. Physician-emergency doctors interpretation of FoCUS yielded acceptable results. |
