Attempts at quality assurance for pediatric emergency point-of-care ultrasound: A single-center descriptive study #MMPMID41355727
Tomita K; Amagasa S; Miyasaka M; Uematsu S
Pediatr Int 2025[Jan]; 67 (1): e70285 PMID41355727show ga
OBJECTIVES: Point-of-care ultrasound (POCUS) requires technical expertise, making quality assurance (QA) a major challenge. We evaluated POCUS utilization and quality in the pediatric emergency department of the National Center for Child Health and Development (NCCHD). METHODS: We retrospectively reviewed patients aged <18 years who underwent POCUS or radiology-performed ultrasound (RADUS) between June 2023 and May 2024. We mainly evaluated POCUS metrics-image storage, documentation, protocol-specific appropriate storage, and diagnostic delays-and compared them across provider categories and scanning protocols. Diagnostic delay cases were additionally reviewed. RESULTS: Of 2004 patients, 1683 underwent POCUS and 384 RADUS. For POCUS, the rates of overall image storage, documentation, protocol-specific appropriate image storage, and diagnostic delay were 97.4%, 83.6%, 90.8%, and 0.4%, respectively. Documentation rates were significantly lower among nondedicated physicians than among pediatric emergency medicine (PEM) physicians and fellows (both p < 0.01); their protocol-specific appropriate image storage rate was also significantly lower than that of PEM fellows (p = 0.03). Across scanning protocols, the rates of documentation and protocol-specific appropriate image storage differed significantly (both p < 0.01). Among six diagnostic delays, two resulted from acquisition errors, two from interpretation errors, and two from early scans in the disease course; four of these six delays involved the abdominal emergency screening protocol. CONCLUSION: This study identified challenges in POCUS implementation at NCCHD, including quality gaps among nondedicated physicians, the need for clearer follow-up in early presentations, and the importance of protocol design aligned with clinical indications. Sharing QA practices may help refine POCUS strategies for diverse pediatric emergency settings.
Pediatr+Int 2025 ; 67 (1): e70285
