Point-of-care ultrasound (POCUS) refers to non-radiologist clinicians who perform an ultrasound during a clinical encounter with their patient. Rather than performing a comprehensive exam of an organ or body part, the POCUS sonographer uses the ultrasound to answer a specific, focused clinical question, or as an aid in performing a procedure. Ultrasound delivers no ionizing radiation and usually does not require sedation; additionally, POCUS delivers immediate results at the point of care.
POCUS has been used in adult emergency medicine for over 20 years, and is making its way into pediatric emergency rooms and critical care settings. While many pediatric hospitalists are familiar with procedural ultrasound, diagnostic POCUS is relatively new to the field. The purpose of this chapter is to familiarize hospitalists with POCUS in general, including basic physics and use of the machine as well as review indications that have been used or show promise for future use in pediatric medicine.
Developing a productive and sustainable pediatric hospital medicine POCUS program requires significant expertise, resources, and time. No standards for credentialing and quality assurance exist for pediatric hospitalists, yet both are fundamental. Training standards have been published by the American College of Radiology and the American Institute of Ultrasound in Medicine, but pediatric emergency medicine physicians have found consensus guidelines from the American College of Emergency Physicians more geared to the focused POCUS exam, and therefore more applicable to them.1 Programs should establish minimum numbers of exams and didactic hours, and work with the hospital’s credentialing committee. Partnerships with radiology can form the basis for quality assurance and aid in credentialing. Local pediatric or adult emergency medicine programs may have expertise in purchasing and maintaining appropriate portable equipment, and often set the standard in training, monitoring, and clinical use of POCUS.
The point person for the program needs to be well trained in ultrasonography, understand the goals of POCUS, and be able to instruct and evaluate other clinicians as well as set competency standards. Evidence of improved patient outcomes should dictate which specific examinations are taught and performed. Each program must decide which examinations suit their particular needs, but there is no substitute for routine, frequent use with expert feedback in building competency.
Although advances in ultrasound technology have produced more affordable portable machines with excellent image quality, the purchase and maintenance of equipment is expensive. Leaders of the ultrasound program must consider multiple factors before meeting with vendors. Machine choice depends on specific examinations considered in the initial training (and examinations that may be added later), the sophistication of the user, power supply, size and maneuverability of the unit and its stand (which depends on location of use and storage), interfaces with hospital radiology systems and the internet, durability, costs, and service package. Service packages must be scrutinized, including the speed of replacing parts, ...