Point-of-Care Ultrasound for the Pediatric Hospitalist’s Practice

Abstract

Point-of-care ultrasound (POCUS) has the potential to provide real-time valuable information that could alter diagnosis, treatment, and management practices in pediatric hospital medicine. We review the existing pediatric POCUS literature to identify potential clinical applications within the scope of pediatric hospital medicine. Diagnostic point-of-care applications most relevant to the pediatric hospitalist include lung ultrasound for pneumothorax, pleural effusion, pneumonia, and bronchiolitis; cardiac ultrasound for global cardiac function and hydration status; renal or bladder ultrasound for nephrolithiasis, hydronephrosis, and bladder volumes; soft tissue ultrasound for differentiating cellulitis from abscess; and procedural-guidance applications, including line placement, lumbar puncture, and abscess incision and drainage. We discuss POCUS applications with reviews of major pathologic findings, research gaps, the integration of POCUS into practice, and barriers to implementation.

The Unmet Demand for Point-of-Care Ultrasound Among General Pediatricians: A Needs Assessment

“…Supporting this notion, family medicine is also heavily outpatient and clinical practice overlaps with pediatrics, yet other studies have found that graduates from family medicine programs where POCUS is taught continue to use POCUS in their clinical practice (31). Prior review articles on pediatric POCUS have focused on the role of POCUS in the practice of the pediatric hospitalist (1,11,(15)(16)(17)32). However, the majority of pediatric residents in our study were interested in POCUS, and over half of them planned to practice outpatient general pediatrics.…”

“…Interestingly, pediatricians ranked neck (lymph node vs abscess), advanced abdominal (appendicitis, intussusception, hypertrophic pyloric stenosis, cholecystitis) among the most useful diagnostic applications. These studies tend to be considered more advanced by POCUS experts (11,15). While the POCUS literature for pediatric appendicitis (34,35) and intussusception(36, 37) is growing, there is currently limited evidence to support the use of POCUS for differentiation of neck masses (3,38,39).…”

“…An electronic survey was distributed via email, social media, and iers with a quick response (QR) code that linked to the survey. The survey was created in Qualtrics (Qualtrics, Provo, UT) based on prior needs assessments designed for family medicine and internal medicine(18-21) Speci c pediatric POCUS applications were selected based on published reviews describing the scans most pertinent to pediatric POCUS (1,11,15) and based on input from 2 of the authors (AS, MLM), who are experts in pediatric POCUS. The survey was then reviewed by medial education experts from a variety of specialties for clarity and breadth.…”

Lung Ultrasonography for the Diagnosis of Pleural Effusion in Children

“…Anteroposterior chest radiographs can overlooked quite a number of effusion cases that can be detected by CT scan and ultrasonography. Pleural effusion is often misinterpreted as parenchymal opacity (Soni et al, 2015) Although CT scan is the gold standard for the diagnosis of pleural effusion, ultrasonography shows similar accuracy of sensiti-vity and specificity (Kurian et al, 2009;Hopkins et al, 2019) The ability of lung ultrasonography to identify complex effusions in pediatric patients correlates with chest radiograph and CT scan (k= 1,0) (Hopkins et al, 2019) .…”

Point of care B mode ultrasound in Neurological Emergencies

“…Bedside ultrasound allows diagnostic, therapeutic and monitoring approaches in critically ill patients (1). Currently, ultrasound enables to perform almost a scan of all body regions in both adult and pediatric populations (2,3).…”