Nilam Soni, MD, FHM; Thomas Conlon, MD; Ria Dancel, MD, FAAP, FHM; Daniel Schnobrich, MD
Point-of-care ultrasound (POCUS) is rapidly gaining acceptance in the medical community as a goal-directed examination that answers a specific diagnostic question or guides a bedside invasive procedure. Adoption by pediatric hospitalists is increasing, aided by multiple training pathways, opportunities for scholarship, and organization development.
The use of POCUS is increasing among nonradiologist physicians due to the expectation for perfection, desire for improved patient experience, and increased availability of ultrasound machines. POCUS is rapid and safe, and can be used serially to monitor, provide procedural guidance, and lead to initiation of appropriate therapies.
Training in POCUS in limited applications is possible in short periods of time. One recent study showed that approximately 40% of POCUS cases led to new findings or alteration of treatment. However, POCUS requires training, monitoring for competence, transparency of training/competence, and a QA process that supports the training. One solution at Children’s Hospital of Philadelphia was to use American College of Emergency Physician guidelines for POCUS training.
Pediatric applications include guidance of bladder catheterization, identifying occult abscesses, diagnosis of pneumonia and associated parapneumonic effusion, and IV placement. More advanced applications include diagnosis of appendicitis, intussusception, and increased intracranial pressure. Novel applications conceived by nonradiologist physicians have included sinus ultrasound.
Initial training can be provided by “in-house experts,” such as pediatric ED physicians and PICU physicians. Alternatively, an on-site commercial course can be arranged for larger groups. Consideration should be given to mentorship, with comparison to formal imaging and/or clinical progression. Relationships with traditional imagers should be cultivated, as POCUS can potentially be misunderstood. In fact, formal US utilization has been found to increase once clinicals begin to use POCUS.
Key takeaways for HM
- Point-of-care ultrasound (POCUS) is rapidly being adopted by pediatric hospitalists.
- Pediatric applications are still being developed, but include guidance of bladder catheterization, identifying occult abscesses, diagnosis of pneumonia/associated effusions, and IV placement.
- Initial training can be provided by pediatric ED physicians/PICU physicians or an on-site commercial course can be arranged for larger groups.
- Relationships with radiologists should be established at the outset to avoid misunderstanding of POCUS.
Dr. Chang is a pediatric hospitalist at Baystate Children’s Hospital and is the pediatric editor of The Hospitalist.