Taking the Pulse of POCUS: The State of Point-of-Care Ultrasound at a Pediatric Tertiary Care Hospital

Abstract

We aim to quantify and categorize point-of-care ultrasound (POCUS) usage by pediatric practitioners and trainees at our tertiary care center, and assess the degree of interest from pediatric residents, fellows, and program leaders for integrating POCUS into their training. Data was collected via online survey, evaluating the current use of POCUS in clinical decision making, desire for further formal training, and opinions on the importance of POCUS to future clinical practice. In total, 14 program directors/assistant program directors (PD/APDs) representing 10 of 15 training programs, 30 of 95 fellows representing 9 of 15 fellowships, and 32 of 82 residents responded. From PD/APDs, only 2 of the programs reported active use POCUS for clinical decision making, but 13 of the fellows and 9 residents reported doing so. In regard to desire for a formal POCUS program, 30.8% of PD/APDs, 43.8% of fellows without current curricula, and 87.5% of residents were interested in participating in such a program. When considering specialty, some non-acute care-based PD/APDs and fellows at our institution felt that POCUS was important to future practice. Pediatric subspecialty PD/APDs and their fellows had divergent outlooks on the importance of POCUS in future practice. Finally, an overwhelming majority of residents at our institution expressed a desire to learn, and half believing it will be important to future practice. Based on the degree of interest, medicolegal considerations, and trajectory of patient care, pediatric residency and fellowship programs should strongly consider integrating POCUS education into their curricula.

Point of Care Ultrasound in Pediatric Surgery across the European Region—European Pediatric Surgery Association Endorsed Survey

“…The possibility to use ultrasonography at the bedside by using mobile or hand-held devices particularly benefits pediatric patients by avoiding transfer and changing environments. [4][5][6][7] 1 Personal information about respondent…”

“…This is contrasted with the United States where clinician-led ultrasound (POCUS) is increasingly incorporated in a multitude of training programs, particularly in pediatric emergency medicine. [1][2][3][4][5] The literature that evaluates POCUS use in surgery mainly focuses on surgeons performing FAST scans, ultrasound-assisted vascular access, soft tissue assessment, regional anaesthesia, focused echocardiography, and ultrasound guidance for other interventional procedures. 2,12 Trainees report increased self-efficacy and confidence even after short course lengths, that is, a total of 14 hours.…”

“…However, several studies have shown that for basic indications such as appendicitis and intussusception, trained clinicians are able to perform ultrasound with reliable accuracy, leading to a reduction in time to diagnosis for the patient. 2,4,5,7,9,11,15,16 The individual free-text responses from participants in the survey do highlight some conflicting views as to whether pediatric surgeons should formally incorporate POCUS into their practice. Looking across the Atlantic, precedent has been set to incorporate clinician-led ultrasound into undergraduate curricula and many different residency training programs.…”