Impact of Point-of-Care Ultrasonography on the Management of Hospitalized Pediatric Patients

BACKGROUND AND OBJECTIVES Although evidence supports the use of point-of-care ultrasonography (POCUS) in many clinical settings, pediatricians have not widely adopted POCUS. Our objective is to illustrate the impact of POCUS within a children’s hospital by describing a registry of cases in which POCUS guided or changed management. METHODS This is an observational study of a pediatric POCUS registry in an academic children’s hospital. Patient cases were included if POCUS guided or changed diagnostic or procedural management. Cases were identified by the physicians performing the examination, and encounters were separately reviewed. We summarize characteristics of POCUS encounters, including our categorization of diagnostic or procedural changes made as a result. RESULTS We identified 66 patients (median age, 5.5 years [interquartile range, 1–15]) who had 76 POCUS encounters during which ultrasonography changed management or guided a procedure. There were 31 diagnostic POCUS encounters performed on 29 patients. Diagnostic POCUS encounters led to a change in primary diagnosis (48%), changed disposition by facilitating or preventing discharge or transfer to higher levels of care (36%), prompted a procedure (29%), expedited specialist consultation (26%), or obviated additional imaging (19%). There were 45 procedural POCUS encounters performed on 37 patients. Procedural POCUS led to salvaged procedures (49%), prevented placement of unnecessary central venous catheters (16%), and avoided unnecessary procedures (4%). CONCLUSIONS This study describes the impact of POCUS in the care of patients in a children’s hospital. Our results may serve as an impetus for further study, training, and adoption of POCUS within hospital pediatrics.