P0510 - Interpretation of Emergency Department Focused Cardiac Ultrasonography by Pediatric Emergency Medicine Physicians and Pediatric Cardiologists

Background:
Point of care ultrasound, including focused cardiac ultrasound (FOCUS), is a diagnostic tool with rising popularity, particularly in the pediatric emergency department. National societies in both emergency medicine and echocardiography regard FOCUS as an expeditious method to assess specific cardiovascular findings that may affect clinical management. Barriers to gain widespread acceptance among other subspecialties include image quality, interpretation, and ability to affect patient outcome. As such, we sought to compare these barriers in images acquired by pediatric emergency medicine (PEM) faculty as reviewed by pediatric cardiologists with advanced training in echocardiography.

Methods:
This is a retrospective observational review of FOCUS examinations obtained over one year at a large, tertiary care, pediatric emergency department. Images were obtained and immediately interpreted by PEM physicians and learners, then retrospectively reviewed for quality assurance (QA) by EM physicians fellowship trained in ultrasonography. Acquired images were assessed by three pediatric cardiologists for image quality and interpretation. The electronic medical record was reviewed to determine patient presentations and outcomes.

Results:
We reviewed 558 patient charts evaluated by an EM QA sonographer. Our cardiologists reviewed 384 sets of FOCUS images that met inclusion criteria; the majority of exclusions were due to incomplete documentation. The average patient age was 9.57 ± 4.92 years, and 195 (50.8%) patients were male. Many patients (42.2%) had no significant medical history, and the most common chief complaint was chest pain or discomfort (24.7%). The average assessment of image quality via Likert scale rating by the cardiologist was 2.96 ± 0.71 while the EM QA assessment was significantly higher at 3.39 ± 0.59 (p<0.0001). The inter-class correlation coefficient (ICC) among the cardiology reviewers was 0.75. The cardiologists found abnormalities in 7.8% of studies, and the PEM physicians in 8.7%. Of these studies the most common pathology was pericardial effusion, 9 per cardiologists versus 6 per PEM sonographers. Full echocardiograms were obtained in 31 (8.1%) patients, while cardiologists recommended additional imaging in 35 (9.1%).

Conclusions:
Although there was no comparative, significant difference between FOCUS interpretation and clinical outcome, image quality was the prevailing barrier to overall assessment. These findings help to understand mitigating factors for FOCUS acceptance by other subspecialties.