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Accuracy of Pediatric Interventricular Septal Thickness Measurement Obtained Via Point-of-Care Ultrasound: A
Ahmed Hasan1, Nessy Dahan, Adetunbi Ayeni
1From the NewYork-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, NY.
Insights
Pediatric emergency medicine physicians can accurately measure interventricular septum thickness using point-of-care ultrasound (POCUS). This diagnostic tool shows high agreement with pediatric cardiologists, aiding in hypertrophic cardiomyopathy detection.
Area of Science:
- Cardiology
- Pediatric Emergency Medicine
- Medical Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic cardiovascular disease often missed in pediatric patients due to asymptomatic presentation.
- Traditional diagnosis relies on echocardiography for interventricular septal thickness, but point-of-care ultrasound (POCUS) by pediatric emergency medicine (PEM) physicians is emerging as a viable alternative.
- PEM physicians performing POCUS demonstrate comparable accuracy to pediatric cardiologists in diagnosing HCM.
Purpose of the Study:
- To assess the diagnostic accuracy of POCUS in measuring interventricular septum end-diastole (IVSd) thickness.
- To evaluate the effectiveness of ultrasound-trained PEM physicians in performing cardiac POCUS in a pediatric emergency setting.
- To compare POCUS measurements by PEM physicians with those of pediatric cardiologists.
Main Methods:
- A prospective, single-center, observational diagnostic accuracy study was conducted.
- Pediatric patients presenting to the emergency department with symptoms prompting cardiac POCUS were enrolled (n=48).
- Interventricular septum end-diastole (IVSd) thickness was measured by PEM physicians at the bedside and retrospectively by a pediatric cardiologist.
Main Results:
- Excellent diagnostic agreement (81.25%) was observed between PEM physicians and pediatric cardiologists in measuring IVSd thickness.
- Disagreement occurred in 18.75% of cases, with a mean error of -0.32.
- The overall mean error for IVSd measurements was -0.046, indicating high concordance (P=0.008).
Conclusions:
- Point-of-care ultrasound (POCUS) performed by ultrasound-trained PEM physicians is highly accurate for measuring pediatric IVSd thickness.
- POCUS demonstrates excellent agreement with measurements made by pediatric cardiologists.
- This validates POCUS as a reliable tool for HCM assessment in pediatric emergency departments.
Background:
Hypertrophic cardiomyopathy is a genetic, life-threatening cardiovascular disease that often goes unidentified in pediatric patients. Patients are often asymptomatic and neither history or physical examination are reliable to detect the disease. The only reliable method to diagnose hypertrophic cardiomyopathy is with echocardiography to look at interventricular septal thickness. Emerging literature has shown that cardiac point-of-care ultrasound (POCUS) performed by pediatric emergency medicine (PEM) physicians is as effective and accurate compared with cardiac echocardiography performed by pediatric cardiologists.
Objective:
The objective of the study was to determine the diagnostic accuracy of POCUS performed by ultrasound-trained PEM physicians in measuring the interventricular septum end diastole (IVSd) thickness in the pediatric emergency department.
Methods:
We conducted a prospective, single-center, observational, diagnostic accuracy study to examine the diagnostic accuracy of POCUS in measuring IVSd thickness in pediatric patients who presented to the pediatric emergency department with symptoms that prompted a cardiac POCUS. Cardiac POCUS findings were interpreted by a PEM physician at the bedside and retrospectively by a pediatric cardiologist. Diagnostic concordance of the measurements obtained by the PEM physician and cardiologist was assessed.
Results:
Forty-eight patients were enrolled. Median patient age was 13.4 years. There was excellent diagnostic agreement on the measurement of the IVSd thickness between PEM physicians and the pediatric cardiologist (81.25% of cases; 39/48). Disagreement was seen in 18.75% of the cases (9/48). The mean error of disagreement was -0.32, with a 95% confidence interval of -0.37 to -0.28. Overall, the mean error of both agreement and disagreement was -0.046, with 95% confidence interval of -0.08 to -0.01 and P value of 0.008.
Conclusions:
Point-of-care ultrasound performed by ultrasound-trained PEM physicians to measure pediatric IVSd thickness has a high diagnostic accuracy with excellent agreement with a pediatric cardiologist.
