Evaluating Frequency and Yield of Echocardiography in a Pediatric Intensive Care Unit

To evaluate the frequency and diagnostic yield of transthoracic echocardiography (TTE) in a noncardiac pediatric intensive care unit (PICU).

This was a single-center retrospective observational study of a 48-bed quaternary-care PICU. Patients younger than 18 years who had a TTE performed during their PICU stay from February 3, 2015, to December 8, 2022, were included, and patients on extracorporeal membrane oxygenation support were excluded.

We analyzed 2633 TTEs from 1445 patients, with only the first study included for patients with multiple TTEs. The median age of all patients was 4.4 years (IQR 1-12.4 years). Low ventricular function, defined as moderate or severe systolic dysfunction, was found in 6% of all TTEs, whereas 94% showed hyperdynamic, normal, or mildly diminished ventricular function. TTEs were classified into 25 categories on the basis of indications. Low ventricular function was present in 10% of shock cases, 17% of cardiac arrests, and 2% of respiratory failures. Among cases of respiratory failure, 88% showed no pulmonary hypertension. A low yield group, comprising 16% of total first TTEs, included acute respiratory failure, persistent tachycardia, abnormal electrocardiograms, and systemic hypertension. Among those evaluated for pulmonary hypertension, 62% showed no evidence of it, whereas 4% exhibited severe pulmonary hypertension, all with a pre-existing history. For pericardial effusion evaluation, 82% had no or trivial-small effusion.

TTE frequently is used in the noncardiac PICU, but its diagnostic yield varies widely on the basis of clinical indications. This study emphasizes the need for careful use of TTE in the PICU, with consideration of pretest probability and clinical context to enhance diagnostic effectiveness in critically ill pediatric patients.