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Pediatr Radiol. 2016 Feb;46(2):219-28. doi: 10.1007/s00247-015-3467-9. Epub 2015 Oct 6.

Diagnostic accuracy of point-of-care ultrasound for catheter-related thrombosis in children.

Author information

1
Pediatric Intensive Care Unit, Maria Fareri Children's Hospital, Valhalla, NY, USA.
2
Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT, USA.
3
Department of Radiology, Maria Fareri Children's Hospital, Valhalla, NY, USA.
4
Pediatric Intensive Care Unit, Yale-New Haven Children's Hospital, New Haven, CT, USA.
5
Department of Pediatrics, Yale School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA.
6
Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, CT, USA.
7
Department of Pediatrics, Yale School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA. vince.faustino@yale.edu.

Abstract

BACKGROUND:

Compared with consultative US performed by the radiology department, point-of-care US performed by non-radiology physicians can accurately diagnose deep venous thrombosis in adults.

OBJECTIVE:

In preparation for a multicenter randomized controlled trial, we determined the accuracy of point-of-care US in diagnosing central venous catheter-related thrombosis in critically ill children.

MATERIALS AND METHODS:

Children <18 years old with a central venous catheter who were admitted to the intensive care unit were enrolled. Consultative and point-of-care compression ultrasounds with Doppler were done on the vein where the catheter was inserted within 24 h after insertion. Repeat US was obtained within 24 h of removal of the catheter. All images were centrally, blindly and independently adjudicated for thrombosis by a team of pediatric radiologists. Chance-corrected agreement between readings was calculated.

RESULTS:

From 84 children, 152 pairs of consultative and point-of-care ultrasounds were analyzed. A total of 38 (25.0%) consultative and 17 (11.2%) point-of-care ultrasounds were positive for thrombosis. The chance-corrected agreement between consultative and point-of-care ultrasounds was 0.17 (standard error: 0.07; P = 0.008). With consultative US as a reference, the sensitivity of point-of-care US was 28.1% (95% confidence interval: 13.7%-46.7%) with a specificity of 91.8% (95% confidence interval: 84.4%-96.4%). A catheter in the subclavian vein was associated with discordant readings (adjusted odds ratio: 4.00; 95% confidence interval: 1.45-13.94).

CONCLUSION:

Point-of-care US, when performed by non-radiology physicians and centrally adjudicated by pediatric radiologists in the setting of a multicenter randomized controlled trial, may not accurately diagnose catheter-related thrombosis in critically ill children.

KEYWORDS:

Central venous catheter; Children; Intensive care unit; Point-of-care ultrasound; Ultrasound; Venous thromboembolism

PMID:
26440129
PMCID:
PMC4738063
DOI:
10.1007/s00247-015-3467-9
[Indexed for MEDLINE]
Free PMC Article
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