Attempts at quality assurance for pediatric emergency point-of-care ultrasound: A single-center descriptive study

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).

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.

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.

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.