(1376) POCUS Utilization by Advanced Practice Providers Compared to Intensivists: (CUSP) Survey Data

Introduction: Point-of-care ultrasound (POCUS) is a fundamental skill in pediatric and adult critical care. Despite the critical role Advanced Practice Providers (APPs) play in the ICU, data on their use of POCUS is limited. This secondary analysis, leveraging data from the International Critical Ultrasound Penetration (CUSP) survey conducted in May and June 2024, aims to describe POCUS adoption among critical care APPs.

Methods: The survey, distributed via the SCCM listserv using random and snowball sampling methods, targeted critical care practitioners. Respondents identified their POCUS use for procedural (vascular access and other POCUS-directed procedures) and diagnostic applications in the past year. The questionnaire included both basic and advanced POCUS uses, with responses on a five-point Likert scale recoded as “almost always” (yes/no) for descriptive analysis. Comparative analysis between physicians and APPs was performed using chi-square tests.

Results: Among 503 respondents from 39 countries, 410 (81.6%) were physicians and 92 (18.3%) were APPs. APPs were predominantly from high-income countries (94.6% vs. 73.8%, p< 0.001) and adult ICUs (92.4% vs. 76.1%, p< 0.001). Physicians reported more additional POCUS training compared to APPs (84.2% vs. 67.4%, p< 0.001). However, APPs were more likely to use ultrasound for central venous catheter placement (98.8% vs. 86.4%, p< 0.01) and arterial line placement (73.6% vs. 51.6%, p< 0.001). Physicians used POCUS more frequently for lumbar puncture (16.3% vs. 6.5%, p=0.015), thoracocentesis (75.6% vs. 58.7%, p=0.001), and tracheostomy (26.8% vs. 7.6%, p< 0.001). Diagnostic use of POCUS was similar between physicians and APPs, except for pleural effusion diagnosis (54.4% vs. 31.4%, p< 0.001). Adult intensivists more frequently used POCUS for lung pathology, intracranial pressure assessment, ascites, and gallbladder pathology compared to adult APPs.

Conclusions: APPs reported POCUS usage comparable to intensivists, particularly for vascular access procedures. These findings emphasize the need for targeted educational offerings on POCUS for diverse critical care providers. Further research should investigate barriers and facilitators to POCUS adoption and its impact on clinical outcomes.