(1069) Clinical Application of POCUS in Critical Care: Differences Between Adult and Pediatric Practices

Introduction: POCUS is a core competency in critical care medicine. However, there is insufficient knowledge about the actual penetration of POCUS in clinical practice. Most surveys on point-of-care ultrasound are limited to specific specialties, preventing comparisons of relative utilization across fields. The Critical Ultrasound Penetration Survey (CUSP) was conducted among SCCM members in early 2024. The objective of this analysis was to compare the use of POCUS between pediatric and adult practitioners.

Methods: The CUSP survey assessed how often POCUS was used for procedures and diagnostic applications in qualified patients. Respondents selected their POCUS usage on a scale (never, rarely [ < 25%], sometimes [26-50%], often [51-75%], and almost always [>76%]). For this analysis, a binary variable was defined as "almost always" using POCUS vs not. The relative application between pediatric and adult practitioners was compared using the chi-square test.

Results: Out of 503 respondents (39 countries), 398 (79.1%) were adult and 105 (20.8%) were pediatric practitioners. A larger proportion of the pediatric respondents were from high-income (Hi) countries (92.4% vs. 73.8%, p< 0.001), from academic centers (92.2% vs. 73.8%, p=0.002), and were physicians (93.3% vs. 78.6%, p=0.005). Pediatric practitioners were more likely to always use POCUS for femoral central line (82.5% vs. 69%, p=0.006) and arterial line placements (66.4% vs. 52.7%, p=0.01). Adult practitioners were more likely to always use POCUS for applications such as thoracentesis (75.6% vs. 60.9%, p=0.003), paracentesis (66.6% vs. 23.8%, p< 0.01), and ECMO cannulation (17.8% vs. 4.7%, p=0.0009). Adult practitioners had significantly higher standard use for diagnostic applications such as LV function (47.6% vs. 17.1%, p< 0.001), Cardiac valves (23.8% vs. 4.3%, p< 0.001), pulmonary POCUS (26.8% vs. 8.9%, p< 0.001), abdominal POCUS (13.9% vs. 2%, p=0.0008), DVT (19.0% vs. 6.1%, p=0.002). The significant differences between adult and pediatric practitioners persisted in sub-cohorts of respondents from HI countries, physicians, and academic centers.

Conclusions: Despite efforts in POCUS training, the routine use of POCUS in various clinical applications (other than vascular access) is low, with even lower utilization in pediatric patients.