At SHM Converge 2025, Shelia Swartz, MD, MPH, associate professor at the Medical College of Wisconsin in Milwaukee, shared practical insights into the use of point-of-care ultrasound (POCUS) to enhance pediatric inpatient care. She emphasized ultrasound’s dual role in expediting clinical decision making and re-engaging learners and families at the bedside.
This session highlighted the increasing relevance of ultrasound as a tool to make abstract clinical assessments visible and immediate. Throughout the talk, case-based examples were used to demonstrate how ultrasound can be applied in real-world scenarios to improve diagnosis and management without requiring advanced imaging skills.
Cases and applications
Lung Pathology: A 10-year-old patient with pneumonia was used to show how ultrasound differentiates simple effusions, complex empyema, and lung consolidation. In real time, POCUS helps determine whether urgent intervention like chest tube placement is needed or if a patient can safely await further imaging or specialist evaluation.
Bronchiolitis Management: An 18-month-old with persistent respiratory symptoms and an inconclusive chest X-ray demonstrated how lung ultrasound can provide clues to disease severity and trajectory. As lung disease progresses, ultrasound findings transition from A-lines to confluent B-lines and eventually to subpleural consolidations.
Lumbar Puncture Support: Two spinal cases illustrated ultrasound’s utility across age groups. In a four-day-old neonate with a failed lumbar puncture (LP), ultrasound was used to detect the presence of fluid before reattempting LP, preventing unnecessary trauma. In a 15-year-old with suspected pseudotumor cerebri, ultrasound helped identify the spinal midline and interspinous space, improving procedural success, which is particularly useful in patients with elevated BMI.
Bladder and Foley Assessment: A 16-year-old patient with hematuria and urinary retention after Foley placement demonstrated how bedside bladder ultrasound can quickly detect catheter malfunction due to clot obstruction, prompting timely flushing of the catheter.
Soft Tissue Imaging: Ultrasound was presented as a quick and effective tool to differentiate cellulitis, lymphatic swelling, and abscesses. In neonates with mastitis, ultrasound helped track improvement over time, reinforcing medical management decisions without unnecessary interventions.
Throughout the session, Dr. Swartz stressed that POCUS is accessible to hospitalists without formal radiology training. However, success requires hands-on practice and familiarity with normal and abnormal patterns. She encouraged the use of visual aids, consistent probe marker orientation, and saved images to build credibility and facilitate interdisciplinary communication.
The session concluded with a discussion on credentialing, billing, and malpractice considerations. Notably, a review of pediatric malpractice cases suggested that failure to use POCUS appropriately, rather than misinterpretation, was a more common medicolegal issue. Clear documentation and consistent skill development were emphasized as essential for safe practice.
POCUS was presented not just as a technical skill, but as an important bridge between clinical reasoning, patient-centered care, and team-based teaching.
Key Takeaways
- POCUS is a highly practical tool for bedside diagnosis and decision making across common pediatric presentations.
- Applications include lung assessment, hydration status, lumbar puncture guidance, bladder evaluation, and soft tissue imaging.
- Hands-on practice and consistent image interpretation are crucial for developing and maintaining proficiency.
- Hospitalists are encouraged to integrate ultrasound use routinely into patient care rather than reserving it for high-stakes scenarios.
- Credentialing, documentation, and interdisciplinary communication are important for the safe and sustainable integration of ultrasound into pediatric hospital medicine.
- Early partnerships with radiology and administrative teams can support credentialing and billing efforts.
Dr. Tran is an assistant professor of clinical pediatrics at the University of Illinois College of Medicine and a pediatric hospitalist at OSF St. Francis Children’s Hospital, both in Peoria, Ill. She is the deputy editor of digital media for the Journal of Hospital Medicine and pediatrics editor for The Hospitalist.