POCUS literature primer: key papers on first-trimester pregnancy and scrotal POCUS

This study aimed to determine the five most influential publications on first-trimester pregnancy point-of-care ultrasound (POCUS) and the five most influential publications on scrotal POCUS from an emergency medicine perspective. These two POCUS applications were selected, because they address time-sensitive clinical conditions in which early diagnosis is critical for appropriate management.

An expert panel of 15 emergency physicians was recruited from the Canadian Association of Emergency Physicians (CAEP) Emergency Ultrasound Committee and the Canadian Ultrasound Fellowship Collaborative. All participants had completed fellowship training in POCUS or possessed equivalent expertise, were actively engaged in scholarly work, and held leadership roles at the institutional or national level. A structured three-round modified Delphi process was conducted to achieve consensus. In each round, panelists independently nominated and ranked papers based on their perceived influence in informing us on how to use POCUS in clinical practice. Responses were discussed and refined across subsequent rounds until agreement was reached.

In round one, panelists nominated 40 papers focused on first-trimester pregnancy POCUS and 31 papers on scrotal POCUS. Following round two, 13 papers remained for first-trimester pregnancy POCUS and 10 for scrotal POCUS, with one additional paper added to each category after panel discussion. The final round produced ranked lists of the five most influential papers in each category. These papers emphasize the diagnostic value of POCUS in confirming intrauterine pregnancy and excluding ectopic pregnancy, its role in the timely recognition of testicular torsion, and its contribution to improving efficiency while reducing emergency department length of stay.

This expert consensus provides a focused reading list of foundational literature in first-trimester pregnancy and scrotal POCUS. The compilation serves as a practical educational resource for clinicians and trainees and as a framework to support future research, curriculum development, and evidence-informed POCUS implementation.