title: Transthoracic echocardiography in pediatric intensive care: impact on medical and surgical management.
abstract: OBJECTIVE
  Although transthoracic echocardiography is commonly performed in the PICU, its utility is not specifically known. The purpose of this investigation was to evaluate the clinical impact of echocardiography in the PICU in terms of frequency of unanticipated findings and the frequency and nature of clinical management changes attributed to the results of echocardiography.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  Nineteen-bed combined medical-surgical-cardiac PICU at a tertiary care children's hospital.
  
  
  METHODS
  All patients in PICU undergoing transthoracic echocardiography.
  
  
  RESULTS
  Data collected included echocardiography indications, pre-echocardiography clinical assessment of anticipated echocardiography findings, height, weight, primary diagnosis, age, and urgency (stat vs routine) of echocardiography. Input of the attending care team (intensivist, cardiologist, and/or cardiovascular surgeon) allowed classification of echocardiography results as either confirming the pre-echocardiography impression, altering the pre-echocardiography clinical impression regarding the indication for which the test was performed, or altering the impression by virtue of new findings unrelated to the specific indication. The nature of the new findings were recorded and categorized. The team recorded clinical management changes made in response to the echocardiography results; the nature of these were listed and categorized. Echocardiograms (n = 416) were performed in 132 patients. Of these, 244 echocardiograms (59%) were ordered on male patients, 31% were under 30 days old, median age was 103 days, 379 (91%) had a primary cardiac diagnosis, and 92 (22%) were ordered stat. Sixty-three percent of echocardiograms confirmed and 24% altered the pre-echocardiography impression regarding the indication for the echocardiography; 13% introduced new findings unrelated to the indication. Cardiac surgical revision was the management change required in 26 patients (6.3%). Stat echocardiography was more likely to alter the pre-echocardiography assessment than routine echocardiography (p < 0.001). Management changes were more commonly associated with stat echocardiograms (p = 0.002) and those with new unexpected findings (p < 0.001) but had no demonstrable association with age less than 30 days (p = 0.332).
  
  
  CONCLUSIONS
  Unanticipated echocardiography results are common in the PICU, and they often alter the clinical impressions that prompted the echocardiogram or introduce new findings unrelated to the reason for which the echocardiogram was recorded. Clinical management changes attributable to echocardiography findings are frequent in the PICU, including occasional surgical intervention. Echocardiography adds diagnostic value and contributes to the management approach in the PICU, accounting for its frequent use.
authors.affiliation: 1Division of Pediatric Cardiology, University of Nebraska Medical Center and Children's Hospital and Medical Center, Omaha, NE. 2Division of Critical Care, Children's Hospital and Medical Center, Omaha, NE. 3Division of Cardiothoracic Surgery, Children's Hospital and Medical Center, Omaha, NE.
authors.forename: Shelby
authors.initials: S
authors.lastname: Kutty
authors.forename: Jonah E
authors.initials: JE
authors.lastname: Attebery
authors.forename: Emily M
authors.initials: EM
authors.lastname: Yeager
authors.forename: Swetha
authors.initials: S
authors.lastname: Natarajan
authors.forename: Ling
authors.initials: L
authors.lastname: Li
authors.forename: Qinghai
authors.initials: Q
authors.lastname: Peng
authors.forename: Edward
authors.initials: E
authors.lastname: Truemper
authors.forename: James M
authors.initials: JM
authors.lastname: Hammel
authors.forename: David A
authors.initials: DA
authors.lastname: Danford
mesh_terms: D016638:Critical Illness; D004452:Echocardiography; D005260:Female; D006331:Heart Diseases / Q000000981:diagnostic imaging* / Q000601:surgery / Q000628:therapy*; D006801:Humans; D033162:Incidental Findings; D007223:Infant; D007231:Infant, Newborn; D015278:Intensive Care Units, Pediatric; D008171:Lung Diseases / Q000000981:diagnostic imaging; D008297:Male; D011446:Prospective Studies; D013997:Time Factors