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

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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.

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Acknowledgments

This work was supported in part by grants to Dr. Polikoff from the National Institutes of Health (T32 HD068201), and to Dr. Faustino from the National Institutes of Health (CTSA Grants Numbers UL1 TR000142 and KL2 TR000140) and American Heart Association (Award Number 14CRP20490002).

Conflicts of interest

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Author information

Authors and Affiliations

  1. Pediatric Intensive Care Unit, Maria Fareri Children’s Hospital, Valhalla, NY, USA

    Simon Li & Matthew G. Pinto

  2. Department of Diagnostic Radiology, Yale School of Medicine, New Haven, CT, USA

    Cicero T. Silva & Kenneth E. Baker

  3. Department of Radiology, Maria Fareri Children’s Hospital, Valhalla, NY, USA

    Adele R. Brudnicki

  4. Pediatric Intensive Care Unit, Yale-New Haven Children’s Hospital, New Haven, CT, USA

    Joana A. Tala

  5. Department of Pediatrics, Yale School of Medicine, 333 Cedar St., New Haven, CT, 06520, USA

    Lee A. Polikoff & E. Vincent S. Faustino

  6. Center for Outcomes Research and Evaluation, Yale University/Yale-New Haven Hospital, New Haven, CT, USA

    Li Qin

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  1. Simon Li
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  2. Cicero T. Silva
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  3. Adele R. Brudnicki
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  4. Kenneth E. Baker
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  5. Joana A. Tala
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  6. Matthew G. Pinto
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  7. Lee A. Polikoff
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  8. Li Qin
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  9. E. Vincent S. Faustino
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Northeast Pediatric Critical Care Research Consortium

Corresponding author

Correspondence to E. Vincent S. Faustino.

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Li, S., Silva, C.T., Brudnicki, A.R. et al. Diagnostic accuracy of point-of-care ultrasound for catheter-related thrombosis in children. Pediatr Radiol 46, 219–228 (2016). https://doi.org/10.1007/s00247-015-3467-9

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  • DOI: https://doi.org/10.1007/s00247-015-3467-9

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