title: Diagnostic accuracy of point-of-care ultrasound for catheter-related thrombosis in children.
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.
  
  
  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).
  
  
  CONCLUSIONS
  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.
authors.affiliation: Pediatric Intensive Care Unit, Maria Fareri Children's Hospital, Valhalla, NY, USA.
authors.forename: Simon
authors.initials: S
authors.lastname: Li
authors.affiliation: Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Cicero T
authors.initials: CT
authors.lastname: Silva
authors.affiliation: Department of Radiology, Maria Fareri Children's Hospital, Valhalla, NY, USA.
authors.forename: Adele R
authors.initials: AR
authors.lastname: Brudnicki
authors.affiliation: Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT, USA.
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Baker
authors.affiliation: Pediatric Intensive Care Unit, Yale-New Haven Children's Hospital, New Haven, CT, USA.
authors.forename: Joana A
authors.initials: JA
authors.lastname: Tala
authors.affiliation: Pediatric Intensive Care Unit, Maria Fareri Children's Hospital, Valhalla, NY, USA.
authors.forename: Matthew G
authors.initials: MG
authors.lastname: Pinto
authors.affiliation: Department of Pediatrics, Yale School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA.
authors.forename: Lee A
authors.initials: LA
authors.lastname: Polikoff
authors.affiliation: Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, CT, USA.
authors.forename: Li
authors.initials: L
authors.lastname: Qin
authors.affiliation: Department of Pediatrics, Yale School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA. vince.faustino@yale.edu.
authors.forename: E Vincent S
authors.initials: EV
authors.lastname: Faustino
mesh_terms: D017677:Age Distribution; D015984:Causality; D062905:Central Venous Catheters / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D003237:Connecticut / Q000453:epidemiology; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D000067716:Point-of-Care Testing / Q000706:statistics & numerical data*; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D017678:Sex Distribution; D014463:Ultrasonography / Q000706:statistics & numerical data*; D056824:Upper Extremity Deep Vein Thrombosis / Q000000981:diagnostic imaging* / Q000453:epidemiology*
keywords: Central venous catheter; Children; Intensive care unit; Point-of-care ultrasound; Ultrasound; Venous thromboembolism