P0290 - Effect of a Point-of-Care Ultrasound (POCUS) Curriculum on Emergency Department Soft Tissue Management

Introduction:
Pediatric emergency department (ED) visits for superficial skin and soft tissue infections (SSTI) have steadily been increasing. It is now known that point-of-care ultrasound (POCUS) is highly sensitive and specific for diagnosing SSTI, differentiating abscess from cellulitis, and is associated with shorter ED length of stays (LOS). As POCUS is an integral part of SSTI management, we sought to determine the impact on ED management after implementation of a soft tissue POCUS curriculum.

Method:
This was a retrospective pre- and post-interventional study of pediatric patients who presented to the ED for suspected SSTI. A total of 474 patients were identified by the international classification of diseases, 9th and 10th revision codes for abscess or cellulitis. We collected pre-POCUS implementation (2016-2017; n=249) and post-POCUS implementation (2018-2019; n=225) data over 24 months, with a washout period (2017-2018) while faculty and fellows received training on soft tissue POCUS. We included patients from 0-17 years of age. We excluded patients with complicated abscesses, requiring admission to the hospital, and those with secondary diagnoses unrelated to their SSTI. The soft tissue POCUS curriculum required faculty and fellows to complete at least 25 quality assured examinations, 4 hours of continuing medical education, and pass a post-curriculum knowledge assessment. We compared imaging patterns, ED LOS, and median charges pre- to post-implementation.

Results:
We analyzed data on 119 total patients, 38 pre-intervention, and 81 post-intervention. Age and race did not differ significantly between the pre- and post-intervention cohorts. There were significantly more female patients included in the post-intervention cohort (p=0.0075). We found a significant increase in the total number of ultrasounds performed (p=0.017), including both POCUS and radiology ultrasounds (RUS). POCUS increased from 26 to 39 pre- to post-intervention (p=0.0017). There was a trend towards a decrease in ED LOS although this was not statistically significant, 186 vs 170 minutes (p=0.288) pre- to post-implementation. Median total charges were significantly decreased from $3653.00 to $2104.75, p<0.0009.

Conclusion:
Implementation of a soft tissue POCUS curriculum in a pediatric ED was associated with increased POCUS use, decreased LOS, and was found to be cost-effective. These findings highlight the importance of POCUS education and implementation in the management of pediatric SSTI.