712 - Bedside Predictors of Ventricular Dysfunction in Children with Suspected Infection

Publication Number: 3689.712

ROBERT HOFFMANN, Boston Children's Hospital, Boston, MA, United States; Andrew F. Miller, Boston Children's Hospital, Brookline, MA, United States; Matthew Eisenberg, Boston Children's Hospital, Boston, MA, United States; Jeffrey T. Neal, Boston Children's Hospital, Boston, MA, United States; Cynthia A. Gravel, Boston Children's Hospital, Boston, MA, United States; Elaine Chiang, Boston Children's Hospital, Boston, MA, United States; Nathan Georgette, Boston Children's Hospital, Boston, MA, United States

Background: Cardiac systolic dysfunction in pediatric patients with suspected infection can worsen outcomes and complicate early treatment of sepsis. Point-of-care ultrasound (POCUS) enables rapid bedside assessment, but reliable clinical predictors of reduced function prior to vasoactive therapy remain unclear.

Objective: To identify which bedside components of a commonly used sepsis screen are associated with reduced cardiac systolic function on POCUS in children with suspected infection.

Design/Methods: In this retrospective cohort study, we included patients aged 1 month to 21 years with suspected infection who underwent cardiac POCUS before vasoactive therapy (if applicable). Inclusion required a documented heart rate and blood pressure within 24 hours (N=1,019). Cardiac POCUS images were acquired by pediatric emergency medicine bedside providers and qualitatively interpreted for reduced systolic function by fellowship-trained PEM POCUS experts. Sepsis screen (from the Children's Hospital of Philadelphia) components included tachycardia, systolic hypotension, altered mental status, abnormal capillary refill ( < 1 s or >3 s), and a prior high-risk condition (Table 1). A multivariable logistic regression model assessed associations between the sepsis screen components and reduced systolic function on cardiac POCUS. Adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated.

Results: Among 1,019 eligible patients, 46 (4.5%) had reduced systolic function (Table 2). In multivariable analysis, systolic hypotension (aOR = 3.6, 95% CI 1.5-8.8, p = 0.005) and abnormal capillary refill (aOR = 5.4, 95% CI 2.2-13.6, p < 0.001) were associated with reduced function on POCUS. Tachycardia (aOR = 0.85, 95% CI 0.44-1.64, p = 0.63), altered mental status (aOR = 1.20, 95% CI 0.49-2.96, p = 0.69), and a prior high-risk condition (aOR = 1.69, 95% CI 0.76-3.77, p = 0.20) were not associated with reduced systolic function (Figure 1).

Conclusion(s): Reduced systolic function on POCUS among children with suspected infection was uncommon, but associated with the presence of systolic hypotension and abnormal capillary refill. Notably, it was not associated with tachycardia alone. If confirmed in multicenter evaluations, these findings suggest children with these characteristics should be considered at risk for impaired cardiac function and should be targeted for timely recognition and intervention.

Table 1. Components of the Children's Hospital of Philadelphia sepsis screening tool.


Table 2. Patient characteristics and outcomes (N=1019).


Figure 1. Adjusted odds ratios for the outcome of reduced systolic function on cardiac point-of-care ultrasound.
The dots indicate point estimate and the lines indicate the 95% confidence intervals.