Point-of-care ultrasound (POCUS) has become an important adjunct to clinical diagnosis and procedural guidance in the Pediatric Emergency Department (PED), supported by literature demonstrating that its use can improve patient safety and expedite lifesaving care.

POCUS further helps to reduce costs and children’s exposure to ionizing radiation. Not only is POCUS ideally suited for “rule-in” diagnostic applications for many pediatric indications, but ultrasound guidance can also improve the safety and success of common procedures, including placement of central venous catheters (CVCs) and peripheral intravenous (PIV) catheters, thoracentesis, paracentesis, regional anesthesia, lumbar punctures and other procedures.

Lifesaving

One of the most common procedures performed in medicine, overall, is vascular access; its success can be lifesaving for many children who present to the ED. The Agency for Healthcare Research and Quality has identi­fied “use of real-time ultrasound guidance during central line insertion to prevent complications” as one of the 12 most highly rated patient safety practices.

Ultrasound-guided CVC, rather than the traditional blind landmark approach has become the standard of care. In a 2016 policy statement, the American College of Emergency Physicians (ACEP) encourages a new goal for vascular access: the “one-stick standard.”

To achieve it, ACEP recommends the use of POCUS for both CVC and PIV catheter placement, listing such advantages as “improved patient safety, decreased procedural attempts and decreased time to perform many procedures in patients [for] whom the technique would otherwise be dif­ficult.”

Nearly Perfect Accuracy for Diagnosing Intussusception 

In children six months to 2 years of age, intussusception is the leading surgical cause of abdominal obstruction1 and can lead to serious or fatal complications if the diagnosis and treatment are delayed. Due to its ease of performance, safety and reported sensitivities of 98-100% and speci­ficities of 88-100% when performed by radiologists, ultrasound has become the initial diagnostic test of choice.

Ultrasound

Recently, POCUS has been used for this purpose as well, with a recent study revealing that point-of-care ultrasound has a sensitivity of 85% and a speci­ficity of 97% for the evaluation of suspected intussusception.

Ultrasonography can also be used to identify features that might suggest whether the enema reduction will be successful or not. Some of these sonographic features include the absence of blood –flow to the affected bowel, or the presence of surrounding free fluid.

Research into novel applications of POCUS in PEM is rapidly expanding, fueled by the growing recognition that pediatric patients are not simply small adults. It is an exciting time in medicine, as the unique needs of the youngest, most vulnerable patients have inspired an astonishing variety of innovations and discoveries aimed at accelerating the diagnoses of life-threatening conditions and guiding safer, more successful care. 

Critically Ill

With point-of-care ultrasound and the crucial information it provides, PEM physicians are ideally equipped to help critically ill or injured children achieve optimal outcomes.