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Diagnostic Accuracy of Point-of-Care Ultrasound Compared to Standard-of-Care Methods for Endotracheal Tube Placement in Neonates
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  • shabina ariff,
  • Khushboo Ali,
  • mark tessaro,
  • uzair ansari,
  • shaun morris,
  • Sajid Soofi,
  • Hasan Merali
shabina ariff
The Aga Khan University

Corresponding Author:shabina.ariff@aku.edu

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Khushboo Ali
The Aga Khan University
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mark tessaro
The Hospital for Sick Children
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uzair ansari
The Aga Khan University
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shaun morris
The Hospital for Sick Children
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Sajid Soofi
The Aga Khan University
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Hasan Merali
The McMaster Children’s Hospital,
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Introduction: Point of care ultrasound (POCUS) is a useful tool to determine endotracheal tube placement; however, few studies have compared it with standard methods of confirmation. We evaluated the diagnostic accuracy of POCUS and time-to-interpretation for correct identification of tracheal versus esophageal intubations compared to a composite of standard-of-care methods in neonates. Methods: A cross-sectional study was conducted in the Neonatal Intensive Care Unit (NICU) at Aga Khan University Hospital Karachi Pakistan. All required intubations were performed as per NICU guidelines. The ETT placement was determined using standard-of-care methods (auscultation, colorimetric capnography, and chest X-ray) by a clinical team, and simultaneously by POCUS. Timings were recorded for each method by independent study staff. Results: A total of 348 neonates were enrolled in the study. More than half (58%) of intubations were in an emergency scenario. Using an expert as the reference standard, POCUS user interpretation showed 100% sensitivity and 94% specificity. We found a 99.4% agreement (Kappa: 0.96; p<0.001) between the POCUS user and expert. Diagnostic accuracy of POCUS compared with at least two standard-of-care methods demonstrated 99.7% sensitivity, 91% specificity, and 98.9% agreement (Kappa:0.93; p<0.001). The median time required for POCUS interpretation was 3.0 (IQR 3.0 -4.0) seconds for tracheal intubation. The time recorded for auscultation and capnography was 6.0 (IQR 5.0 -7.0) and 3.0 (IQR 3.0-4.0) respectively. Conclusion: POCUS is a rapid and reliable method of identifying ETT placement in neonates. Early and correct identification of airway management is critical to save lives and prevent mortality and morbidity.
17 Jan 2022Submitted to Pediatric Pulmonology
21 Jan 2022Submission Checks Completed
21 Jan 2022Assigned to Editor
23 Jan 2022Reviewer(s) Assigned
07 Feb 2022Review(s) Completed, Editorial Evaluation Pending
12 Feb 2022Editorial Decision: Revise Major
07 Apr 20221st Revision Received
09 Apr 2022Submission Checks Completed
09 Apr 2022Assigned to Editor
09 Apr 2022Reviewer(s) Assigned
25 Apr 2022Review(s) Completed, Editorial Evaluation Pending
26 Apr 2022Editorial Decision: Accept
Jul 2022Published in Pediatric Pulmonology volume 57 issue 7 on pages 1744-1750. 10.1002/ppul.25955