Point of Care Ultrasonography by Novice Medical Students for Detecting Inferior Vena Cava Collapsibility, Aortic Diameter and Overall Left Ventricular Function in Euvolemic Pediatric Patients

BACKGROUND: Point of care ultrasound (POCUS) is a useful tool in assessing volume status and cardiac function in the emergency department (ED). Research has shown that medical students (MS) are capable of learning and performing POCUS, however further research is warranted to assess MS ability to perform POCUS, specifically in the pediatric population. METHODS: 5 MS were trained in POCUS techniques over a 2-week period. Training included a one hour lecture followed by hands on practice with the MS performing an average of 2.4 aorta scans, 4.4 IVC (inferior vena cava) scans and 6.8 cardiac scans on healthy pediatric and adult volunteers during the training period. MS then began staffing a pediatric ED 24 hours a day for 5 weeks in 12 hour shifts. The MS identified euvolemic patients age 13 years or younger and obtained written consent for 135 patients. The MS collected ultrasound images of the IVC, aorta, and heart with a parasternal long view and apical view of each patient. The MS assessed left ventricular ejection fraction, then measured IVC diameter and aorta diameter. Each scan was reviewed for quality of image acquisition and accuracy of interpretation by an ultrasound fellowship trained emergency medicine physician and reviewed by a second faculty if the first disagreed with the MS interpretation. Quality of the scans were graded based on the American College of Emergency Physician's emergency ultrasound standard reporting guidelines' 5-point scale with a score of 3 or above meeting minimum criteria for diagnosis. RESULTS: Each MS averaged 2.4 aorta, 4.4 IVC and 6.8 heart scans on healthy pediatric and adult volunteers during the training period. 135 patients age 1 week to 13 years were enrolled. Complete studies were available for 115 cardiac scans, 112 IVCs and 113 aortas. Faculty graded 110/115 cardiac scans 3 or above (95.6%; 95% CI 90.1-98.6%) and agreed with 106/112 MS interpretations (94.6%; 95% CI 88.7-98.0%). Faculty graded 95/112 IVC scans as a 3 or above (84.8%; 95% CI 76.8-90.9%) and agreed with 97/110 MS interpretations (88.2%; 95% CI 80.6-93.6%). Faculty graded 97/113 aorta scans as a 3 or above (85.8%; 95% CI 78.0-91.7%) and agreed with 99/111 MS interpretations (89.2%; 95% CI 81.9-94.3%). CONCLUSIONS: MS with minimal training can accurately detect IVC collapsibility, measure aortic size and assess cardiac contractility in euvolemic pediatric patients.