Table 1.
Delphi guidelines and results, with mean of answers, where absolutely agree=5, strongly agree=4, agree=3, disagree=2, and absolutely disagree=1
| Finalized Guideline/Practice Point | Round 1 Mean | Round 1 Number Endorsed | Round 2 Mean | Round 2 Number Endorsed |
|---|---|---|---|---|
| POCUS content in pediatric nephrology curriculum | ||||
| Pediatric nephrology POCUS should be introduced by describing ultrasound wave properties, transducer types, ultrasound modes, image orientation and optimization, and common ultrasound artifacts | 4.5 | 9/10 | Finalized in round 1 | Finalized in round 1 |
| Pediatric nephrology POCUS techniques taught should include detection of kidney size and appearance: length, cortical and parenchymal thickness, echogenicity variabilities in neonates and children, as well as pathologies like hydronephrosis, stone, cyst, and free fluid | 4.3 | 9/10 | Finalized in round 1 | Finalized in round 1 |
| Pediatric nephrology POCUS techniques taught should include usage during procedures such as temporary hemodialysis catheter placement, kidney biopsy, and suprapubic urine sample collection | 4.0 | 9/10 | Finalized in round 1 | Finalized in round 1 |
| Pediatric nephrology POCUS techniques taught should include ultrasound-guided placement with consideration of probe selection, measurement of depth, diameter, and volume of flow, as well as evaluation of hemodialysis catheters and PD access after placement | 3.5 | 9/10 | Finalized in round 1 | Finalized in round 1 |
| Pediatric nephrology POCUS techniques taught should include evaluation of renal allografts for hydronephrosis, perinephric collections, vascular anastomosis, and resistive index | 4.1 | 9/10 | Finalized in round 1 | Finalized in round 1 |
| Pediatric nephrology POCUS techniques taught should include lung ultrasound, consisting of detection of A and B lines, as well as detection of pleural effusion, consolidations, and atelectasis | 3.8 | 9/10 | Finalized in round 1 | Finalized in round 1 |
| In the pediatric nephrology POCUS curriculum, a focused cardiac and IVC ultrasound, consisting of usages of M-mode and color Doppler modes and evaluation of cardiac anatomy, and IVC anatomy can be taught to trainees interested in advanced POCUS applications | 3.2 | 6/10 | 4.5 | 10/10 |
| In the pediatric nephrology POCUS curriculum, venous Doppler (VExUS) consisting of selected Doppler echocardiographic parameters such as stroke volume assessment, right ventricular systolic pressure and pulmonary artery pressures as well as Doppler evaluation of the systemic veins including hepatic, portal, and intrarenal veins can be taught to trainees interested in advanced POCUS applications | 2.9 | 6/10 | 4.0 | 10/10 |
| Pediatric nephrology POCUS can be used to identify volume status and hemodynamic stability via a combination of cardiac and pulmonary assessments. This can be taught to trainees interested in advanced POCUS applications | 3.6 | 7/10 | 3.9 | 10/10 |
| Pediatric nephrology POCUS is suitable to answer focused clinical questions at the bedside and provide rapid diagnosis for the trained clinician | 3.9 | 8/10 | 4.4 | 10/10 |
| POCUS curriculum delivery method | ||||
| The ideal pediatric nephrology POCUS curriculum should be multi-modal and incorporate elements from online video-based lectures, in-person demonstrations, hands-on training including simulation sessions, and ongoing practice and assessment | 4.1 | 9/10 | Finalized in round 1 | Finalized in round 1 |
| Competency in pediatric nephrology POCUS should be assessed by trained teachers or objective assessments such as multiple choice question POCUS knowledge assessments and skill assessments with simulations or clinical examination exercises. A minimum number of scans performed should not be the sole assessment of competency | 3.8 | 8/10 | 4.7 | 10/10 |
| Pediatric nephrology POCUS programs require institutional support for billing and quality assurance of studies | 3.8 | 9/10 | Finalized in round 1 | Finalized in round 1 |
| A wide variety of probes is recommended for pediatric nephrology POCUS based on the organ being scanned and patient size | 4.3 | 9/10 | Finalized in round 1 | Finalized in round 1 |
| Need for POCUS curriculum | ||||
| Pediatric nephrology POCUS is a recommended skill for residents and fellows to learn and achieve competence before graduation | 3.9 | 8/10 | 4.6 | 10/10 |
| Pediatric nephrology POCUS is a skill that requires a formalized program and institutional support | 4.0 | 9/10 | Finalized in round 1 | Finalized in round 1 |
IVC, inferior vena cava; PD, peritoneal dialysis; POCUS, point-of-care ultrasound; VExUS, Venous Excess Ultrasonography Score.