PERFUSE: A Pilot Prospective Evaluation of Multiorgan Doppler Point-of-Care Ultrasound in Pediatric Sepsis

Sepsis remains a leading cause of morbidity and mortality in children. Biomarkers such as lactate, procalcitonin (PCT), and Erythrocyte Sedimentation Rate (ESR) are commonly used for risk stratification, but their predictive accuracy is variable. Point-of-care ultrasound (POCUS) enables rapid, bedside assessment of hemodynamics and organ perfusion. We introduce PERFUSE (Point-of-care Evaluation of Renal, Flow, and Splanchnic Ultrasound in Emergency care), a multi-organ Doppler-based POCUS evaluation for pediatric sepsis. The objective of this study was to evaluate the feasibility and physiologic trends of PERFUSE in pediatric patients presenting to the emergency department (ED) with sepsis.

This pilot prospective observational study included pediatric patients aged 2–18 years presenting to the ED with sepsis or non-sepsis diagnoses. Patients were identified using the Phoenix criteria, which incorporate objective markers of organ dysfunction across cardiovascular, respiratory, neurologic, and renal domains. All patients underwent PERFUSE evaluation—including left ventricular outflow tract velocity time integral (LVOT VTI), renal resistive index (RRI), and superior mesenteric artery (SMA) Doppler—prior to sepsis-directed interventions. Non-septic patients with abnormal Phoenix components were included for comparison. Statistical analyses were performed to compare PERFUSE parameters between groups.

Eighteen patients were enrolled (7 septic, 11 non-septic). Mean age was 15.0 ± 2.7 years in the septic group and 12.0 ± 2.8 years in the non-septic group; most patients were female. Vital signs were similar between groups, although septic patients demonstrated higher heart rates (123 ± 4.1 vs. 96.7 ± 11.1 bpm; p=0.62). Mean Lactate for septic patients was 1.6+0.4 and Mean ESR was 51+12.1. LVOT VTI was higher in septic patients (9.6 ± 1.5 vs. 6.6 ± 0.9; p=0.07). Mean RRI (0.79 ± 0.1 vs. 0.78 ± 0.0; p=0.82) and SMA indices (0.81 ± 0.1 vs. 0.82 ± 0.0; p=0.61) were similar between groups.

PERFUSE is a feasible bedside POCUS evaluation for pediatric patients presenting with suspected sepsis. While no statistically significant differences were observed in this pilot study, observed physiologic trends support further investigation in larger, adequately powered cohorts to define its diagnostic and prognostic utility.