Applications of point-of-care ultrasound on the heart and great vessels in pediatric emergency departments: a systematic scoping review
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Purpose: Point-of-care ultrasound (POCUS) has become a vital rapid diagnostic tool in emergency departments (EDs) for evaluating the adult heart and great vessels, notably in detecting conditions like aortic dissections. Compared to the adult applications, its use in pediatric emergency settings, however, has been less clearly defined. The authors sought to systematically assess the existing literature on POCUS applications in pediatric EDs specifically focusing on its use in examining the heart and great vessels. Methods: A systematic scoping review was conducted across databases including SpringerLink, PubMed, ScienceDirect, Embase, and Wiley, with structured filtering and screening followed by data extraction. We included studies available up to August 2024, in which emergency physicians used POCUS to assess the conditions of the heart or great vessels in pediatric patients who visited EDs. Results: Fourteen studies met the inclusion criteria. Common applications included dehydration assessment using the inferior vena cava measurements (n = 6), detection of pericardial effusion and systolic dysfunction (n = 6), identification of structural abnormalities (n = 2), and emergency interventions for acute heart failure, multisystem inflammatory syndrome, or shock (n = 3), mutually inclusive. For pericardial effusion or systolic dysfunction, sensitivities and specificities of POCUS ranged from 97.5% to 100%. For dehydration, sensitivities ranged from 65% to 97%, with a 42%-89% specificity, highlighting inconsistencies in the methods and metrics of assessing the inferior vena cava for dehydration. Conclusion: This review highlights the utility of POCUS in pediatric emergency settings targeted preferentially at diagnosing pericardial effusion or systolic dysfunction, with a relatively moderate performance for dehydration. By reviewing existing literature, the study demonstrates the potential of POCUS as a reliable diagnostic tool for a range of pediatric cardiac conditions in EDs.
Abstract
Purpose: Point-of-care ultrasound (POCUS) has become a vital rapid diagnostic tool in emergency departments (EDs) for evaluating the adult heart and great vessels, notably in detecting conditions like aortic dissections. Compared to the adult applications, its use in pediatric emergency settings, however, has been less clearly defined. The authors sought to systematically assess the existing literature on POCUS applications in pediatric EDs specifically focusing on its use in examining the heart and great vessels. Methods: A systematic scoping review was conducted across databases including SpringerLink, PubMed, ScienceDirect, Embase, and Wiley, with structured filtering and screening followed by data extraction. We included studies available up to August 2024, in which emergency physicians used POCUS to assess the conditions of the heart or great vessels in pediatric patients who visited EDs. Results: Fourteen studies met the inclusion criteria. Common applications included dehydration assessment using the inferior vena cava measurements (n = 6), detection of pericardial effusion and systolic dysfunction (n = 6), identification of structural abnormalities (n = 2), and emergency interventions for acute heart failure, multisystem inflammatory syndrome, or shock (n = 3), mutually inclusive. For pericardial effusion or systolic dysfunction, sensitivities and specificities of POCUS ranged from 97.5% to 100%. For dehydration, sensitivities ranged from 65% to 97%, with a 42%-89% specificity, highlighting inconsistencies in the methods and metrics of assessing the inferior vena cava for dehydration. Conclusion: This review highlights the utility of POCUS in pediatric emergency settings targeted preferentially at diagnosing pericardial effusion or systolic dysfunction, with a relatively moderate performance for dehydration. By reviewing existing literature, the study demonstrates the potential of POCUS as a reliable diagnostic tool for a range of pediatric cardiac conditions in EDs.