The Use of Point-of-Care Ultrasound in Children with Medical Complexity

Research Objectives: To investigate the use of Point-of-Care ultrasound (POCUS) in pediatric post-acute rehabilitation for children with medical complexity (CMC) and its potential to be incorporated into clinical care and change outcomes.

Design: Prospective observational study using bedside POCUS

Setting: A pediatric inpatient post-acute care/rehabilitation hospital providing inpatient care for CMC who require daily ongoing hospital level of care to prevent or reduce impairment, decrease activity limitations, and improve participation.

Participants: All CMC for whom a POCUS was requested by the rehabilitation team were eligible. 32 participants/6 months. Mean age was 5 years (0.41-18 years). 56% male. 41% multiple congenital anomalies, 31% neurologic/neuromuscular disorders, and 25% prematurity. All 32 CMC had technology dependence: Enteral feeding (100%), Mechanical ventilation via tracheostomy (88%), VP shunt (16%), ostomy (6%), CVL (3%), non-invasive respiratory support (3%). No legal guardians refused the study.

Interventions: Hospital staff were provided with lectures and bedside teaching in the use of POCUS. POCUS was obtained at the bedside to answer a specific clinical question.

Main Outcome Measures: To evaluate the number and type of POCUS referrals by hospital staff for clinical management, and to evaluate findings and outcomes.

Results: 98 POCUS studies were performed-31 lung ultrasounds, 22 cardiac, 10 diaphragmatic, 7 abdominal, 7 cranial, 6 musculoskeletal/soft tissue, 5 biliary, 5 renal, 3 deep vein thrombosis, and 2 liver/spleen measurement.
Abnormal findings were identified in 14/32 patients (44%) and included: 2 pleural effusions and 2 consolidations on lung ultrasound; 1 pericardial effusion and 1 pulmonary hypertension on cardiac ultrasound; 7 with diaphragmatic dysfunction; and 1 with deep vein thrombosis.
Ultrasound resulted in a change in management in 12/32 children (37%) including medication changes (2), cancellation or addition of further imaging (4), cancellation of hospital transfer (2), or change in weaning from mechanical ventilation (4).

Conclusions: In CMC, POCUS can be incorporated into clinical care, answer important clinical questions, as well as change management.

Author(s) Disclosures: No disclosures