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Diagnostic Bedside Ultrasound Program Development in Pediatric Critical Care Medicine

Results of a National Survey*

Conlon, Thomas W., MD1; Kantor, David B., MD, PhD2; Su, Erik R., MD3; Basu, Sonali, MD4; Boyer, Donald L., MD, MSEd1; Haileselassie, Bereketeab, MD, MHS5; Petersen, Tara L., MD6; Su, Felice, MD7; Nishisaki, Akira, MD, MSCE1

doi: 10.1097/PCC.0000000000001692
Online Clinical Investigations

Objectives: To assess current diagnostic bedside ultrasound program core element (training, credentialing, image storage, documentation, and quality assurance) implementation across pediatric critical care medicine divisions in the United States.

Design: Cross-sectional questionnaire-based needs assessment survey.

Setting: Pediatric critical care medicine divisions with an Accreditation Council of Graduate Medical Education-accredited fellowship.

Respondents: Divisional leaders in education and/or bedside ultrasound training.

Interventions: None.

Measurements and Main Results: Fifty-five of 67 pediatric critical care medicine divisions (82%) with an Accreditation Council of Graduate Medical Education-accredited fellowship provided responses. Overall, 63% of responding divisions (34/54) were clinically performing diagnostic bedside ultrasound studies with no difference between divisions with large versus small units. Diagnostic bedside ultrasound training is available for pediatric critical care medicine fellows within 67% of divisions (35/52) with no difference in availability between divisions with large versus small units. Other core elements were present in less than 25% of all divisions performing clinical studies, with a statistically significant increase in credentialing and documentation among divisions with large units (p = 0.048 and 0.01, respectively). All core elements were perceived to have not only high impact in program development but also high effort in implementation. Assuming that all structural elements could be effectively implemented within their division, 83% of respondents (43/52) agreed that diagnostic bedside ultrasound should be a core curricular component of fellowship education.

Conclusions: Diagnostic bedside ultrasound is increasingly prevalent in training and clinical use across the pediatric critical care medicine landscape despite frequently absent core programmatic infrastructural elements. These core elements are perceived as important to program development, regardless of division unit size. Shared standardized resources may assist in reducing the effort in core element implementation and allow us to measure important educational and clinical outcomes.

1Department of Anesthesiology and Critical Care Medicine, The Children’s Hospital of Philadelphia, Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA.

2Division of Critical Care Medicine, Boston Children’s Hospital, Boston, MA.

3Department of Anesthesiology and Critical Care Medicine, Johns Hopkins Children’s Center, Baltimore, MD.

4Division of Critical Care Medicine, Children’s National, Washington, DC.

5Departments of Pediatrics and Chemical Systems Biology, Stanford University School of Medicine, Palo Alto, CA.

6Division of Critical Care Medicine, The Medical College of Wisconsin, Milwaukee, WI.

7Division of Critical Care Medicine at Stanford University and Stanford Children’s Health, Palo Alto, CA.

*See also p. 1091.

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Dr. Conlon received funding from the Society of Critical Care Medicine (SCCM) Ultrasound Pediatric and Neonatal course (travel) and the Japanese Society of Intensive Care Medicine (JSICM) (travel and honorarium). Dr. Kantor received support for article research from the National Institutes of Health. Dr. Su’s institution received funding from General Electric Company with a material support grant for a study on Catheter-Associated Thrombosis in Critically Ill Children, and he received funding from SCCM (for activities pertaining to educational programs) and the Children’s Hospital of Philadelphia (for Ultrasound Education). Dr. Nishisaki received funding from the SCCM Ultrasound Pediatric and Neonatal course (travel) and JSICM (travel and honorarium). The remaining authors have disclosed that they do not have any potential conflicts of interest.

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©2018The Society of Critical Care Medicine and the World Federation of Pediatric Intensive and Critical Care Societies