Tripathi, Sandeep

ABSTRACT Objective To describe the practice patterns of point‐of‐care ultrasound (POCUS) and compare its usage across subgroups (adult vs. paediatric practitioners, physicians vs. nurse practitioners [NPs], high income [HI] vs. low and middle ‐income [LMI] countries). Methods Survey distributed via the Society of Critical Care Medicine in May–June 2024. Respondents reported the percentage of eligible patients in the past year for whom POCUS was used for vascular access and diagnostic purposes. Responses (0%, < 25%, 25%–50%, 50%–75%, > 75%) were converted into binary categories (> 50% use) and compared across subgroups using logistic regression. Results The survey was completed by 503 respondents from 39 countries (6% response rate): 77.7% from HI countries, 20.9% paediatric practitioners and 18.3% Nurse Practitioner (NPs)/Physician assistants (PAs). POCUS was commonly used for vascular access, and similar usage was found among NP/PAs, physicians, and adult and paediatric practitioners. Practitioners from LMI countries were less likely to use POCUS for vascular access. Basic diagnostic applications, such as assessing pleural effusion (72.5%) and left ventricular function (69.2%), were more commonly used than advanced applications like pulmonary artery pressure measurement (22%). Physicians were more likely than NPs (for some indications), and adult practitioners were more likely than paediatric practitioners (for most indications) to use POCUS for diagnostic purposes. Practitioners in LMI countries reported higher use of diagnostic applications than practitioners in HI countries. Conclusions POCUS is widely adopted in critical care but is less accepted for diagnostic use among paediatric practitioners and NP/PAs. Diagnostic utilisation is higher in LMI countries, while procedural use is lower. Impact Statement Point‐of‐care ultrasound (POCUS) is increasingly used in intensive care units to guide diagnosis and procedures. Despite its importance, little is known about how consistently it is used by different types of clinicians around the world. This international survey of critical care practitioners from 39 countries shows that POCUS is widely used, particularly for procedures, but diagnostic use remains uneven. Paediatric clinicians and advanced practice providers report lower diagnostic use, while clinicians in low‐ and middle‐income countries report higher diagnostic adoption. These findings highlight opportunities to improve access to training and support broader, more equitable use of POCUS in critical care.

INTRODUCTION A retrospective cohort study on patients aged &lt; 18 years included in the Society of Critical Care Medicine: Viral Infection and Respiratory Illness Universal Study registry from March 2020 to April 2024 with an objective of calculating the prevalence of sepsis as defined by the Phoenix Sepsis Score (PSS) and to validate the PSS with respect to outcomes in children with COVID-19. METHODS Linear mixed-effects regression was used to examine the relationship between the PSS and hospital length of stay after controlling for confounding factors. The performance of the PSS was assessed using the receiver operating characteristic (ROC) and the precision-recall curve (PRC). Cross-validation was performed using leave-one-out cross-validation. RESULTS Out of 1731 patients (58 hospitals), 326 (18.8%) met criteria for sepsis and 167 (9.7%) for septic shock. The overall mortality was 1.4% (25/1731), with significant differences between nonseptic (10/1405, 0.7%) and both sepsis (15/326, 4.6%) and septic shock (9/167, 5.4%) groups. After adjusting for confounders, the septic group was associated with a longer hospital length of stay than the nonseptic group. One unit increase in the numeric PSS led to a 70% increase in risk of mortality (odds ratio 1.70; P &lt; .001). The area under the ROC curve was 0.80 and the area under the PRC curve was 0.13. The threshold of ≥ 2 for detection of mortality had a sensitivity of 0.63, specificity of 0.82, and positive predictive value of 0.05. CONCLUSION Phoenix Sepsis Criteria retain its validity in identifying sepsis in children with COVID-19 and can be used in further epidemiological studies in this population

Background: There is a paucity of multicenter data describing the impact of coronavirus disease 2019 (COVID-19) on hospitalized pediatric oncology patients. Using a large, multicenter, Society of Critical Care Medicine (SCCM) Discovery Viral Infection and Respiratory Illness University Study (VIRUS) database, we aimed at assessing outcomes of COVID-19 infection in this population. Method: This is a matched-cohort study involving children below 18 years of age hospitalized with COVID-19 between March 2020 and January 2021. Using the VIRUS; COVID-19 Registry database, children with oncologic diseases were compared with propensity score matched (age groups, sex, race, and ethnicity) cohort of children without oncologic diseases for the prevalence of Multisystem Inflammatory Syndrome in Children (MIS-C), intensive care unit (ICU) admission, interventions, hospital, and ICU length of stay. Results: The number of children in the case and control groups was 45 and 180, respectively. ICU admission rate was similar in both groups ([47.7 vs 51.7%], P=0.63). The proportion of children requiring noninvasive and invasive mechanical ventilation, and its duration were similar between groups, same as hospital mortality. Interestingly, MIS-C was significantly lower in the oncology group compared with the control (2.4 vs 24.6%; P=0.0002). Conclusions: In this study using a multicenter VIRUS database, ICU admission rate, interventions, and outcomes of COVID-19 were similar in children with the oncologic disease compared with control patients. The incidence of MIS-C is lower in oncologic patients.

ImportanceThere is limited evidence for therapeutic options for pediatric COVID-19 outside of multisystem inflammatory syndrome in children (MIS-C).ObjectiveTo determine whether the use of steroids within 2 days of admission for non–MIS-C COVID-19 in children is associated with hospital length of stay (LOS). The secondary objective was to determine their association with intensive care unit (ICU) LOS, inflammation, and fever defervescence.Design, Setting, and ParticipantsThis cohort study analyzed data retrospectively for children (&amp;lt;18 years) who required hospitalization for non–MIS-C COVID-19. Data from March 2020 through September 2021 were provided by 58 hospitals in 7 countries who participate in the Society of Critical Care Medicine Discovery Viral Infection and Respiratory Illness Universal Study (VIRUS) COVID-19 registry.ExposureAdministration of steroids within 2 days of admission.Main Outcomes and MeasuresLength of stay in the hospital and ICU. Adjustment for confounders was done by mixed linear regression and propensity score matching.ResultsA total of 1163 patients met inclusion criteria and had a median (IQR) age of 7 years (0.9-14.3). Almost half of all patients (601/1163, 51.7%) were male, 33.8% (392/1163) were non-Hispanic White, and 27.9% (324/1163) were Hispanic. Of the study population, 184 patients (15.8%) received steroids within 2 days of admission, and 979 (84.2%) did not receive steroids within the first 2 days. Among 1163 patients, 658 (56.5%) required respiratory support during hospitalization. Overall, patients in the steroids group were older and had greater severity of illness, and a larger proportion required respiratory and vasoactive support. On multivariable linear regression, after controlling for treatment with remdesivir within 2 days, country, race and ethnicity, obesity and comorbidity, number of abnormal inflammatory mediators, age, bacterial or viral coinfection, and disease severity according to ICU admission within first 2 days or World Health Organization ordinal scale of 4 or higher on admission, with a random intercept for the site, early steroid treatment was not significantly associated with hospital LOS (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Separate analyses for patients with an LOS of 2 days or longer (n = 729), those receiving respiratory support at admission (n = 286), and propensity score–matched patients also showed no significant association between steroids and LOS. Early steroid treatment was not associated with ICU LOS, fever defervescence by day 3, or normalization of inflammatory mediators.Conclusions and RelevanceSteroid treatment within 2 days of hospital admission in a heterogeneous cohort of pediatric patients hospitalized for COVID-19 without MIS-C did not have a statistically significant association with hospital LOS.