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Point-of-Care Ultrasound in Children With Medical Complexity
Sigmund J Kharasch1,2, Helene Dumas2, Calvin Huang1
1Massachusetts General Hospital, Boston, Massachusetts.
Insights
Point-of-care ultrasound (POCUS) is valuable for children with medical complexity (CMC), revealing abnormalities in lung, diaphragmatic, and cardiac imaging. This technology aids in answering clinical questions and providing essential baseline and follow-up data.
Area of Science:
- Pediatric critical care medicine
- Medical imaging
- Ultrasound technology
Background:
- Children with medical complexity (CMC) present with chronic, multisystem health conditions, functional limitations, and high healthcare needs.
- These children often require specialized care in post-acute settings.
- Understanding the utility of diagnostic tools in this population is crucial.
Purpose of the Study:
- To describe the indications for point-of-care ultrasound (POCUS) in children with medical complexity (CMC).
- To detail the applications of POCUS in this patient group.
- To report POCUS findings in CMC admitted to a pediatric post-acute care hospital.
Main Methods:
- A descriptive study design was employed.
- POCUS scans performed for clinical purposes in CMC patients were analyzed.
- Inclusion criteria included POCUS requests from medical team providers for eligible children.
Main Results:
- 104 POCUS evaluations were conducted across 33 CMC patients.
- Lung, diaphragmatic, and cardiac ultrasounds constituted 57% of all POCUS studies.
- Abnormal findings were frequent, particularly in diaphragmatic (82%) and lung (73%) ultrasounds.
Conclusions:
- Lung, diaphragmatic, and cardiac ultrasound are the most common POCUS applications in post-acute pediatric care.
- POCUS demonstrates significant utility in answering clinical questions for CMC.
- POCUS can provide valuable baseline and follow-up information, potentially expanding its role in managing CMC.
Background And Objectives:
Children with medical complexity (CMC) have significant chronic health conditions that involve congenital or acquired multisystem disease associated with medical fragility, functional limitations, dependence on technology, and high health care utilization. The objective of this study was to describe the indications, applications, and point-of-care ultrasound (POCUS) findings in this population.
Methods:
A descriptive study of POCUS scans performed for clinical purposes in CMC admitted to a single pediatric postacute care hospital. All children for whom a POCUS was requested by a medical team provider were eligible for inclusion.
Results:
One hundred and four POCUS evaluations were performed for 33 patients. Diagnostic groups for the 33 patients included multiple congenital anomalies (41%), neurologic or neuromuscular (31%), prematurity (25%) and cardiac (3%). Lung, cardiac, and diaphragmatic ultrasound accounted for 57% of POCUS requested. POCUS was abnormal in 82% of diaphragmatic, 73% of lung, and 11% of cardiac ultrasounds. Twenty-three percent of POCUS studies were requested to answer a specific clinical question, 56% for follow-up information, and 21% for baseline evaluation.
Conclusions:
Lung, diaphragmatic, and cardiac ultrasound were the most prevalent POCUS studies requested in a postacute care hospital. POCUS may offer an expanded role in such patients and settings by answering clinical questions and by providing baseline and follow-up information.
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