The Impact of Bedside Cardiac Point-of-Care Ultrasound on the Utilization of Cardiology Subspecialty Resources in a Pediatric Emergency Department
Bibliographic record
Abstract
OBJECTIVE: This study sought to determine the impact of cardiac point-of-care ultrasound (cPOCUS) in a pediatric emergency department (ED) on cardiology subspecialty utilization for subjects with chest pain or syncope. Diagnostic yield of cPOCUS and transthoracic echocardiograms (TTEs) for these subjects was also examined. METHODS: A retrospective chart review of subjects presenting to a tertiary pediatric ED with chest pain or syncope 1 year before (2015, pre-cPOCUS group) and 1 year after (2017, cPOCUS group) introduction of cPOCUS was conducted. Subjects aged 2 to 18 years evaluated for these symptoms were included. Those with known heart defects, prior abnormal TTE, or asthma exacerbation at presentation were excluded. In both groups, cardiology subspecialty utilization was assessed by determining whether cardiology referrals, cardiology consultations, or follow-up TTEs were completed. Results of TTEs were reviewed and classified as incidental (no follow-up needed), minor (follow-up needed, but intervention unlikely), moderate (nonurgent intervention needed), and severe (hospitalization/urgent intervention needed). Cardiac point-of-care ultrasound results were compared with any follow-up TTEs. Data were analyzed using χ 2 or Student t test as appropriate. RESULTS: A total of 1230 subjects were analyzed: 595 pre-cPOCUS and 635 cPOCUS group. There was no significant difference in TTEs (42 vs 46), cardiology consultations (36 vs 37), or cardiology referrals (47 vs 37) between groups. Of 67 cPOCUS scans performed, 63 were normal, 3 showed small pericardial effusion, and 2 demonstrated left ventricular dysfunction. Of 88 TTEs in both groups (0.7% subjects), 76 were normal, 5 had incidental, 6 had minor, and 1 had a severe finding present on cPOCUS (0.08% subjects; 95% confidence interval, 0%-0.45%). CONCLUSIONS: The introduction of cPOCUS did not increase cardiology subspecialty utilization in subjects presenting to the pediatric ED with chest pain or syncope. Cardiac point-of-care ultrasound may be useful in evaluating global biventricular systolic function and effusion in this population.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.007 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".