Dissemination of a Pediatric Musculoskeletal POCUS Scoring System via Virtual Education: A Proof-of-Concept Study

Point of care pediatric musculoskeletal POCUS scanning and scoring protocols for childhood arthritis have emerged in recent years. However, pediatric musculoskeletal POCUS curricula in rheumatology fellowship programs are limited due to availability of trained faculty and resources. This proof-of-concept study investigated the effectiveness of educational methods for a pediatric musculoskeletal POCUS scoring protocol among fellows and physicians of differing subspecialties. Educational methods assessed included recorded videos and virtual review sessions. Effectiveness was assessed by calculating interrater reliability for the musculoskeletal POCUS scoring systems using the intra-class correlation coefficient (ICC). Following training sessions, participants then underwent scoring exercise(s) until the goal of an excellent ICC ≥ 0.75 was reached. Four participants completed two rounds of virtual education, review, and scoring sessions. Excellent interrater reliability was achieved for most views. This proof-of-concept study demonstrated virtual education covering advanced concepts of pediatric musculoskeletal POCUS provides a knowledge base for physicians from different subspecialties and various experience.

A Longitudinal Evaluation of a Multimodal POCUS Curriculum in Pediatric Residents

Introduction: Pediatric residency programs often do not include a point of care ultrasound (POCUS) curriculum. We analyzed a novel POCUS curriculum for pediatric residents that incorporated an online question bank (QB), in addition to a traditional teaching model of didactic instruction and hands-on learning experience. Methods: Four high-yield POCUS topics were chosen: Focused Assessment by Sonography for Trauma (FAST), soft tissue, lung, and cardiac. Residents completed online multiple-choice quizzes before and after each of four in-person learning sessions, taught by ultrasound faculty and fellows. At the end of the academic year participants completed a knowledge retention quiz. Confidence surveys were administered to participants throughout the course of the study. Differences in means were compared by Student's t-test. Results: Learners demonstrated post-intervention score improvement for each of the four modules. Retention testing demonstrated retained improvement for the soft tissue and cardiac modules, but not for the FAST module. Self-reported confidence increased across all four topics. Conclusion: A multimodal POCUS curriculum utilizing a combination of an online QB and in-person teaching demonstrated lasting knowledge for pediatric trainees.

Use of point-of-care ultrasound in the diagnosis and treatment of pulmonary oedema in an infant

This case demonstrates the value of perioperative point-of-care ultrasound for rapid bedside evaluation and treatment of pulmonary oedema in an infant. A nine-week-old male infant undergoing cleft lip repair received significant intravenous fluid resuscitation for intraoperative hypotension. After uneventful extubation, he developed increased work of breathing and a gradual decline in oxygen saturation despite supplemental oxygen by way of a facemask. Lung point-of-care ultrasound revealed confluent B-lines in multiple lung fields, consistent with pulmonary oedema, likely from fluid overload. He was treated with furosemide resulting in clinical improvement within 30 minutes.

A Rare Cause of Neck Lump in an Infant

A 5 month old girl presented to the Paediatric Emergency Department with a rapidly growing neck mass over 24 hours. She was systemically well and otherwise asymptomatic. On examination she had a mobile, soft and non-tender 5 cm x 5 cm neck mass. Blood tests were unremarkable with normal inflammatory markers. Point of Care Ultrasound (POCUS) was done which showed a solid left sided neck mass with increased vascularity but no evidence of collection or abscess. Given the atypical presentation and rapid growth the patient was commenced on empirical antibiotics and was discussed with both tertiary ENT and Oncology teams. An MRI was performed which was indeterminate. Biopsy of the neck mass was positive for Ewing Sarcoma. This is a rare case of Ewing Sarcoma in an infant. POCUS can be used to rule out common pathology and abnormal lymph nodes, aiding in ongoing investigation and management in neck lumps.

Point-of-Care Ultrasound for Physicians in Practice - A Training Model for Specialty Specific and Clinically Relevant Skill Development

Point-of-care Ultrasound (POCUS) skills are required competencies for emergency medicine and paediatric emergency medicine training [1,2,3,4]. Over time, more specialties will require these skills of their graduates. Experienced physicians who completed their training before POCUS requirements may ask: How can I gain POCUS skills training and competency? In this perspective piece we describe in-person and asynchronous training programs available to these clinicians in practice. We highlight these programs due to their person-centred design: they maximise the needs of the learner, provide personalised education, and expose them to respected and established POCUS faculty and training centers.