1345: Comparison of Novice Point-of-Care Ultrasound Users to Experts During Rapid Response Team Deployment

Introduction: Point-of-care ultrasound (POCUS) is increasingly used by both novice and expert users in the rapid assessment of critically ill children. Prior studies have suggested that novice POCUS users are able to obtain and interpret ultrasound images with reasonable accuracy as compared to expert users. We hypothesize that the interpretation of ultrasound images obtained by novice users during rapid response team (RRT) deployment will be similar compared to that of experts. Methods: Novice POCUS users (Pediatric Critical Care Medicine fellows who have completed a one-day POCUS training course) used a handheld ultrasound probe in patient assessment during rapid response team activations called for respiratory and/or circulatory failure. Images of the lungs, heart, and IVC were obtained and stored. Novice users interpreted the saved images using a standardized survey. Two expert POCUS users interpreted the deidentified stored images retrospectively using identical survey responses. Novice and expert POCUS users’ responses were compared for concordance. Results: From March to July 2025, 16 RRT assessments were completed using POCUS per study protocol. Interrater reliability was analyzed using Cohen’s kappa and percent agreement. On categorical measures of LV function (n=8), pericardial effusion (n=7), lung sliding (n=7), and pleural effusion (n=4), novices had 100% agreement with experts (100% agreement between expert 1 and 2). When comparing the novice to expert evaluation for all measurements, agreement between novice and experts 1 and 2 was 86.9% and 87.8%, respectively. Across all variables, expert agreement was 90.2% (unweighted kappa 0.66, weighted kappa 0.76). Conclusions: Compared to expert POCUS users, novice users demonstrated perfect agreement in interpreting ultrasound images obtained during pediatric RRT assessments on measures indicative of pathologic findings. These findings suggest that with brief POCUS training, novice users can reliably identify clinically significant imaging abnormalities. Further analysis of additional data will assess the impact of POCUS on clinical decision making and accuracy of differential diagnosis determination.