Feasibility and acceptability of point of care lung ultrasound for identification of acute chest syndrome in an inpatient pediatric hematology unit

Abstract Background: Acute chest syndrome (ACS) is a potentially life-threatening complication of sickle cell disease (SCD). Diagnosis is currently defined by a new pulmonary density on chest imaging encompassing at least one complete lung segment and one of the following: fever, hypoxia, increased work of breathing, chest pain, and/or shortness of breath. Historically, chest x-ray (CXR) has been used as the chest imaging of choice for identification of the pulmonary density. However, CXRs expose patients to ionizing radiation and can be limited when obtained at the bedside. Point of care ultrasound (POCUS) has been shown to be a reliable tool in diagnosis of lung consolidations for patients with SCD in the emergency room setting. However, its implementation in inpatient settings for patients with SCD, where ACS often occurs, remains limited. This pilot study was developed to demonstrate both the feasibility and acceptability of POCUS in the inpatient hematology setting, while also evaluating its ability to identify the development of ACS during hospitalizations for other acute complications (e.g. pain). Here, we describe the feasibility and acceptability portion of the study. Objective: Evaluate the feasibility and acceptability of lung POCUS in diagnosis of ACS for patients with SCD admitted to a pediatric inpatient hematology service Methods: Design/Patient Eligibility: This was a single center prospective cohort study. Patients were eligible for enrollment if they were <25 years of age, admitted to our inpatient hematology unit, had a diagnosis of sickle cell disease, did not have a diagnosis of ACS on admission, and were hemodynamically stable at time of enrollment. Procedure: Lung POCUS was conducted by a physician who had undergone individualized lung ultrasound training, completing greater than 30 lung ultrasounds prior to performing the intervention, which previous POCUS studies have shown to be adequate. Patients underwent POCUS examination on Days 1, 3, and 5 (if still hospitalized), and within 24 hours of any CXR obtained as part of clinical care. Surveys were administered to patients and team members following each POCUS examination. Analysis: Feasibility was determined based on participation rate, retention rate, and ease of performance as defined by duration of ultrasound. Acceptability of the intervention by both patients/family members and medical team members was assessed using a brief survey of Likert-scale questions. Results: Interim analysis showed participation rate of 83% (10 of 12 patients) with 100% retention rate for those participating (10 of 10 patients). Those patients who were not enrolled were unable to be consented due to a language barrier or guardian availability. All lung POCUS were completed in under 10 minutes. Survey analysis showed that POCUS was acceptable to both patients and medical teams involved in the patients' care, with 9 out of 10 agreeing or strongly agreeing that they were overall satisfied with the experience of undergoing lung POCUS. There were no instances of POCUS interfering with patient care. Conclusion: Point of care lung ultrasound is feasible and acceptable for both patients and medical teams in the inpatient hematology setting. Further studies are needed to assess its reliability as compared to the current stand of care when used in the inpatient hematology setting.

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