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From the American Academy of PediatricsPolicy Statement

Point-of-Care Ultrasonography by Pediatric Emergency Medicine Physicians

AMERICAN ACADEMY OF PEDIATRICS, Committee on Pediatric Emergency Medicine, SOCIETY FOR ACADEMIC EMERGENCY MEDICINE, Academy of Emergency Ultrasound, AMERICAN COLLEGE OF EMERGENCY PHYSICIANS, Pediatric Emergency Medicine Committee and WORLD INTERACTIVE NETWORK FOCUSED ON CRITICAL ULTRASOUND
Pediatrics April 2015, 135 (4) e1097-e1104; DOI: https://doi.org/10.1542/peds.2015-0342
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Abstract

Point-of-care ultrasonography is increasingly being used to facilitate accurate and timely diagnoses and to guide procedures. It is important for pediatric emergency medicine (PEM) physicians caring for patients in the emergency department to receive adequate and continued point-of-care ultrasonography training for those indications used in their practice setting. Emergency departments should have credentialing and quality assurance programs. PEM fellowships should provide appropriate training to physician trainees. Hospitals should provide privileges to physicians who demonstrate competency in point-of-care ultrasonography. Ongoing research will provide the necessary measures to define the optimal training and competency assessment standards. Requirements for credentialing and hospital privileges will vary and will be specific to individual departments and hospitals. As more physicians are trained and more research is completed, there should be one national standard for credentialing and privileging in point-of-care ultrasonography for PEM physicians.

Policy – Reaffirmed with Reference & Data Updates

This policy has been reaffirmed with reference and data updates. New or updated references or datapoints are indicated in bold typeface. No other changes have been made to the text or content of the policy.

The AAP would like to acknowledge Jennifer Marin, MD, FAAP, for these updates.

Introduction

Point-of-care ultrasonography is a focused ultrasonography performed and interpreted at the patient’s bedside by a health care provider in conjunction with his or her clinical examination. Point-of-care ultrasonography can expedite clinical decision-making, direct follow-up diagnostic imaging, aid in procedural guidance, and improve patient satisfaction.1–6 Point-of-care ultrasonography is designed to answer specific yes or no questions in real time. The point-of-care ultrasonography examination has important qualities as an imaging modality. There is no need to transport a patient outside of the emergency department (ED), examinations can be performed at all hours, examinations may be repeated, and there is no ionizing radiation exposure. Moreover, it may help direct further evaluation so as to avoid unnecessary and costly testing.

Clinician-performed ultrasonography has been used and accepted since the 1960s, when obstetricians and cardiologists first adopted the technology. The use of ultrasonography by those specialists is endorsed by various professional radiology organizations.7,8 At present, nonphysician providers, such as nurses and prehospital care workers, are also using point-of-care ultrasonography as a part of their practice.9–17

Minimizing Radiation Exposure

One of the appealing aspects of ultrasonography is its inherent safety. It relies on sound waves and not x-rays to generate images. In many instances, computed tomography (CT) imaging or radiography are the optimal diagnostic modalities in the evaluation of the pediatric patient; however, there is an increasingly large body of literature emphasizing and delineating the risks of ionizing radiation, particularly from CT.18–31 Pediatric patients are particularly sensitive to ionizing radiation, given the larger organ-specific dosing they receive with each study, the increased susceptibility of these organs to radiation-induced cancer, and the increased life span over which children may develop radiation-induced cancers.21 In response to this risk, several national campaigns have been initiated to reduce the use of unnecessary CT imaging in pediatric patients. These include efforts by the Society for Pediatric Radiology,32 the National Council on Radiation Protection and Measurements,33 the Food and Drug Administration,34 and the National Cancer Institute.35 In summary, when imaging is indicated, practitioners should attempt to optimize the use of nonradiating diagnostic modalities, such as ultrasonography.

Indications for Point-of-Care Ultrasonography

PEM physicians can use point-of-care ultrasonography as a diagnostic or procedural adjunct in the evaluation of patients in the ED.36 Diagnostic applications are those that assist in diagnosis and inform medical decision-making. Procedural applications may be “ultrasonography-assisted” or “static” or “ultrasonography-guided,” also referred to as “dynamic.” Static ultrasonography is defined as using ultrasonography before the procedure, identifying anatomic structures, and determining the ideal circumstances for the procedure to be performed. The procedure itself is performed without the use of ultrasonography. In contrast, in dynamic ultrasonography, the ultrasonography and procedure are performed simultaneously.

Clinical applications will be practice-specific and based on the patient population, incidence of disease, and the availability of resources, such as 24-hour attending radiologist coverage, availability of ultrasonography technicians, and distance/transfer times to facilities that can provide ultrasonography imaging. ED leaders should determine which point-of-care ultrasonography examinations will be most useful to their practice environments. Physicians would then apply for institutional privileges in those specific areas. There will be a natural transition period for physicians who did not receive point-of-care ultrasonography education as part of their graduate medical training. Therefore, the indications for which clinicians use point-of-care ultrasonography will evolve over time as the education is disseminated throughout the PEM community. Finally, clinicians should be aware that point-of-care ultrasonography is better used as a “rule in” and not a “rule out” diagnostic modality. The absence of an abnormal finding should not indicate a normal examination. For example, nonvisualization of an intussusception with high clinical concern must prompt further evaluation. Likewise, when findings other than those sought to “rule in” a diagnosis are encountered, a more complete imaging evaluation is warranted.

Point-of-Care Ultrasonography Training, Credentialing, and Privileging

Before implementing a program in the ED, departmental leaders should identify a core group of individuals with expertise in point-of-care ultrasonography. This group is responsible for educating faculty and trainees as well as managing administrative tasks, such as outlining credentialing pathways and performing quality assurance image reviews. Standardized and universally accepted criteria for what designates a point-of-care expert are likely to evolve over time as advanced training programs are established. In departments or divisions without point-of care ultrasonography–trained individuals, departmental leadership should consider sending an individual or group of individuals with interest to receive additional training in point-of-care ultrasonography. Alternatively, an expert from another department (eg, general emergency medicine, radiology) may assume these responsibilities and work collaboratively with ED leaders.

Point-of-care ultrasonography training varies depending on the practitioner’s previous education and practice environment. Until now, most PEM physicians have received little or no point-of-care ultrasonography instruction as part of their training. It is important that PEM fellowship programs provide adequate training, including measurements of competency for trainees. Point-of-care ultrasonography education is now an American Board of Pediatrics requirement for PEM fellowship programs.37 Consensus education guidelines and a model curriculum were recently published.38 There are 2 training pathways for physicians: a “training-based” pathway for current trainees and a “practice-based” pathway for faculty without previous experience. The details of such pathways are outlined in the accompanying technical report.39

Before performing a point-of-care ultrasonography examination for medical decision-making, PEM physicians must demonstrate application-specific competency. During this “training” phase, the point-of-care ultrasonography expert should review all ultrasonography examinations in a timely manner. Practitioners can receive relevant feedback regarding their examinations. In addition, novice practitioners should be supervised at the bedside to ensure that the examinations are being performed correctly. Examination reviews and bedside supervision may be performed by a department or division “expert” or by another physician already credentialed to perform ultrasonography for that indication. These educational scans should not be used for medical decision-making or billing purposes, and this should be clearly communicated to patients and their families.

Given that a point-of-care ultrasonography examination is intended to be a focused examination, training requirements necessarily differ from those set forth by other specialty organizations, such as the American College of Radiology and others. A similar distinction was made in the 2002 training guidelines adopted by the American Society of Echocardiography, which outlined basic training requirements for anesthesiologists performing perioperative echocardiography, which differed from the more rigorous training needed for more consultative echocardiography performed by cardiologists.40 Competency and subsequent credentialing within a division or department may be achieved after performing a specified number, or range, of accurately performed and interpreted point-of-care ultrasonography examinations. With the lack of robust data supporting a specified number of examinations per indication, some guidelines suggest 25 to 50 examinations needed to achieve competency.41 However, physicians should not interpret this recommendation as a “one-size-fits-all” approach, because examinations vary in difficulty and therefore may require more experience to establish competency. In addition, the number of examinations performed may not always best define competency. Because point-of-care ultrasonography incorporates both cognitive and psychomotor components, individual physicians may gain competency at varying rates that may be independent of a predetermined numerical goal and better assessed through simulation, observed structured clinical examinations, or direct observation during clinical shifts.

Hospital privileging committees should provide an opportunity for privileging in specific pediatric point-of-care ultrasonography examinations. Written requirements for privileging should be delineated. Building on the recommendations set forth by the American College of Emergency Physicians, when a physician applies for appointment or reappointment to the medical staff and for clinical privileges, the process should include assessment of current competency by the point-of-care ultrasonography director.41 Because point-of-care ultrasonography is a relatively new technology for PEM physicians, some specialists and hospital privileging committees may not be familiar with the precedent already set forth for point-of-care ultrasonography and the benefits to patient care. Therefore, PEM physicians should educate those who are unfamiliar with its use, citing the established literature attesting to emergency physicians’ ability to accurately perform and interpret point-of-care ultrasonography examinations.5,42–105 In addition, PEM physicians should consider collaboration with radiologists and expert sonographers when implementing point-of-care ultrasonography into their ED.

Point-of-Care Ultrasonography Documentation

Once PEM physicians are credentialed to perform point-of-care ultrasonography for a particular application, they can integrate the point-of-care ultrasonography examination into patient care. Details of the point-of-care ultrasonography examination must be documented at the time of performance in the medical record. Specifically, documentation should include the indication for the examination, structures/organs identified, and the interpretation.106 If the study is inadequate, this finding should also be noted. Images should be archived, ideally electronically, and entered as part of the electronic health record for ease of retrieval and review.

Recommendations

  1. PEM physicians should be familiar with the definition and application of point-of-care ultrasonography and the utility for patients in the ED.

  2. Pediatric emergency physicians who integrate point-of-care ultrasonography in their patient care should be competent in point-of-care examinations that are specific and relevant to their clinical environment.

  3. For EDs with a PEM point-of-care ultrasonography program, there must be a process in place for educating and assessing practitioner skill, maintaining quality assurance, implementing quality improvement activities, and acquiring and maintaining hospital privileges.

  4. PEM fellowship programs should have a structured point-of-care ultrasonography education curriculum and competency assessment for fellows in training.

  5. Standardized, universally accepted criteria for what defines point-of-care ultrasonography expertise should be developed in the near future by national organizations such as the American Academy of Pediatrics, the Society for Academic Emergency Medicine, and/or the American College of Emergency Physicians.

Summary

There is an increasing demand for PEM physicians to become adept in point-of-care ultrasonography. Mounting evidence supports the benefits to pediatric patients. This policy statement and accompanying technical report have been developed to define a structured and safe program for the integration and implementation of point-of-care ultrasonography by PEM physicians.

Lead Authors

Jennifer R. Marin, MD, MSc

Resa E. Lewiss, MD

Financial Disclosure/Conflict of Interest

Dr Lewiss has no financial disclosures or potential conflicts of interest. Dr Marin receives support from third Rock Ultrasound, LLC for serving as teaching faculty and received support from the Agency for Healthcare Quality and Research (R13HS023498) related to a conference on diagnostic imaging and from the National Institutes of Health (K12HL109068).

Pediatric Point-of-Care Ultrasound Work Group

Jennifer R. Marin, MD, MSc, Chairperson

Resa E. Lewiss, MD

Alyssa M. Abo, MD

Stephanie J. Doniger, MD, RDMS

Jason W. Fischer, MD, MSc

David O. Kessler, MD, MSc, RDMS

Jason A. Levy, MD, RDMS

Vicki E. Noble, MD, RDMS

Adam B. Sivitz, MD

James W. Tsung, MD, MPH

Rebecca L. Vieira, MD, RDMS

American Academy of Pediatrics, Committee on Pediatric Emergency Medicine, 2013–2014

Joan E. Shook, MD, MBA, FAAP, Chairperson

Alice D. Ackerman, MD, MBA, FAAP

Thomas H. Chun, MD, MPH, FAAP

Gregory P. Conners, MD, MPH, MBA, FAAP

Nanette C. Dudley, MD, FAAP

Susan M. Fuchs, MD, FAAP

Marc H. Gorelick, MD, MSCE, FAAP

Natalie E. Lane, MD, FAAP

Brian R. Moore, MD, FAAP

Joseph L. Wright, MD, MPH, FAAP

Liaisons

Lee Benjamin, MD – American College of Emergency Physicians

Kim Bullock, MD – American Academy of Family Physicians

Elizabeth L. Robbins, MD, FAAP – AAP Section on Hospital Medicine

Toni K. Gross, MD, MPH, FAAP – National Association of EMS Physicians

Elizabeth Edgerton, MD, MPH, FAAP – Maternal and Child Health Bureau

Tamar Magarik Haro – AAP Department of Federal Affairs

Angela Mickalide, PhD, MCHES – EMSC National Resource Center

Cynthia Wright, MSN, RNC – National Association of State EMS Officials

Lou E. Romig, MD, FAAP – National Association of Emergency Medical Technicians

Sally K. Snow, RN, BSN, CPEN, FAEN – Emergency Nurses Association

David W. Tuggle, MD, FAAP – American College of Surgeons

Staff

Sue Tellez

Society for Academic Emergency Medicine (reviewers)

Steven B. Bird, MD

Andra L. Blomkalns, MD

Kristin Carmody, MD

Kathleen J. Clem, MD, FACEP

D. Mark Courtney, MD

Deborah B. Diercks, MD, MSc

Matthew Fields, MD

Robert S. Hockberger, MD

James F. Holmes, Jr, MD, MPH

Lauren Hudak, MD

Alan E. Jones, MD

Amy H. Kaji, MD, PhD

Ian B. K. Martin, MD

Christopher Moore, MD, RDMS, RCMS

Nova Panebianco, MD, MPH

American College of Emergency Physicians, Pediatric Emergency Medicine Committee, 2013–2014

Lee S. Benjamin, MD, FACEP, Chairperson

Isabel A. Barata, MD, FACEP, FAAP

Kiyetta Alade, MD

Joseph Arms, MD

Jahn T. Avarello, MD, FACEP

Steven Baldwin, MD

Kathleen Brown, MD, FACEP

Richard M. Cantor, MD, FACEP

Ariel Cohen, MD

Ann Marie Dietrich, MD, FACEP

Paul J. Eakin, MD

Marianne Gausche-Hill, MD, FACEP, FAAP

Michael Gerardi, MD, FACEP, FAAP

Charles J. Graham, MD, FACEP

Doug K. Holtzman, MD, FACEP

Jeffrey Hom, MD, FACEP

Paul Ishimine, MD, FACEP

Hasmig Jinivizian, MD

Madeline Joseph, MD, FACEP

Sanjay Mehta, MD, Med, FACEP

Aderonke Ojo, MD, MBBS

Audrey Z. Paul, MD, PhD

Denis R. Pauze, MD, FACEP

Nadia M. Pearson, DO

Brett Rosen, MD

W. Scott Russell, MD, FACEP

Mohsen Saidinejad, MD

Harold A. Sloas, DO

Gerald R. Schwartz, MD, FACEP

Orel Swenson, MD

Jonathan H. Valente, MD, FACEP

Muhammad Waseem, MD, MS

Paula J. Whiteman, MD, FACEP

Dale Woolridge, MD, PhD, FACEP

Former Committee Members

Carrie DeMoor, MD

James M. Dy, MD

Sean Fox, MD

Robert J. Hoffman, MD, FACEP

Mark Hostetler, MD, FACEP

David Markenson, MD, MBA, FACEP

Annalise Sorrentino, MD, FACEP

Michael Witt, MD, MPH, FACEP

Staff

Dan Sullivan

Stephanie Wauson

World Interactive Network Focused on Critical Ultrasound Board of Directors (reviewers)

Vicki Noble, MD

Enrico Storti, MD

Jim Tsung, MD

Giovanni Volpicelli, MD

2019 Reference Update Acknowledgment

Jennifer Marin, MD, FAAP

Sue Tellez

Footnotes

  • This document is copyrighted and is property of the American Academy of Pediatrics and its Board of Directors. All authors have filed conflict of interest statements with the American Academy of Pediatrics. Any conflicts have been resolved through a process approved by the Board of Directors. The American Academy of Pediatrics has neither solicited nor accepted any commercial involvement in the development of the content of this publication.

  • Policy statements from the American Academy of Pediatrics benefit from expertise and resources of liaisons and internal (AAP) and external reviewers. However, policy statements from the American Academy of Pediatrics may not reflect the views of the liaisons or the organizations or government agencies that they represent.

  • The guidance in this statement does not indicate an exclusive course of treatment or serve as a standard of medical care. Variations, taking into account individual circumstances, may be appropriate.

  • All policy statements from the American Academy of Pediatrics automatically expire 5 years after publication unless reaffirmed, revised, or retired at or before that time.

References

  1. ↵
    Howard ZD, Noble VE, Marill KA, et al. Bedside ultrasound maximizes patient satisfaction. J Emerg Med. 2013:1–8
    1. Jones AE,
    2. Tayal VS,
    3. Sullivan DM,
    4. Kline JA
    . Randomized, controlled trial of immediate versus delayed goal-directed ultrasound to identify the cause of nontraumatic hypotension in emergency department patients. Crit Care Med. 2004;32(8):1703–1708pmid:15286547
    OpenUrlCrossRefPubMed
    1. Kirkpatrick AW,
    2. Sirois M,
    3. Ball CG,
    4. et al
    . The hand-held ultrasound examination for penetrating abdominal trauma. Am J Surg. 2004;187(5):660–665pmid:15135687
    OpenUrlCrossRefPubMed
    1. Liteplo AS,
    2. Marill KA,
    3. Villen T,
    4. et al
    . Emergency thoracic ultrasound in the differentiation of the etiology of shortness of breath (ETUDES): sonographic B-lines and N-terminal pro-brain-type natriuretic peptide in diagnosing congestive heart failure. Acad Emerg Med. 2009;16(3):201–210pmid:19183402
    OpenUrlCrossRefPubMed
  5. ↵
    1. Melniker LA,
    2. Leibner E,
    3. McKenney MG,
    4. Lopez P,
    5. Briggs WM,
    6. Mancuso CA
    . Randomized controlled clinical trial of point-of-care, limited ultrasonography for trauma in the emergency department: the first sonography outcomes assessment program trial. Ann Emerg Med. 2006;48(3):227–235pmid:16934640
    OpenUrlCrossRefPubMed
  6. ↵
    1. Moore CL,
    2. Copel JA
    . Point-of-care ultrasonography. N Engl J Med. 2011;364(8):749–757pmid:21345104
    OpenUrlCrossRefPubMed
  7. ↵
    American College of Radiology; American College of Obstetricians and Gynecologists; American Institute of Ultrasound in Medicine. ACR-ACOG-AIUM practice parameter for the performance of obstetrical ultrasound. 2007. Available at: www.acr.org/∼/media/ACR/Documents/PGTS/guidelines/US_Obstetrical.pdf. Accessed January 27, 2012
  8. ↵
    1. American College of Cardiology,
    2. American Heart Association,
    3. American College of Physicians–American Society of Internal Medicine,
    4. American Society of Echocardiography,
    5. Society of Cardiovascular Anesthesiologists,
    6. Society of Pediatric Echocardiography
    . ACC/AHA clinical competence statement on echocardiography. J Am Coll Cardiol. 2003;41(4):687–708pmid:12598084
    OpenUrlCrossRefPubMed
  9. ↵
    1. Blaivas M,
    2. Lyon M
    . The effect of ultrasound guidance on the perceived difficulty of emergency nurse-obtained peripheral IV access. J Emerg Med. 2006;31(4):407–410pmid:17046483
    OpenUrlCrossRefPubMed
    1. Brannam L,
    2. Blaivas M,
    3. Lyon M,
    4. Flake M
    . Emergency nurses’ utilization of ultrasound guidance for placement of peripheral intravenous lines in difficult-access patients. Acad Emerg Med. 2004;11(12):1361–1363pmid:15576530
    OpenUrlCrossRefPubMed
    1. Chin EJ,
    2. Chan CH,
    3. Mortazavi R,
    4. et al
    . A pilot study examining the viability of a Prehospital Assessment with UltraSound for Emergencies (PAUSE) protocol. J Emerg Med. 2013;44(1):142–149pmid:22595631
    OpenUrlCrossRefPubMed
    1. Heegaard W,
    2. Hildebrandt D,
    3. Spear D,
    4. Chason K,
    5. Nelson B,
    6. Ho J
    . Prehospital ultrasound by paramedics: results of field trial. Acad Emerg Med. 2010;17(6):624–630pmid:20491683
    OpenUrlCrossRefPubMed
    1. Henderson A,
    2. Andrich DE,
    3. Pietrasik ME,
    4. Higgins D,
    5. Montgomery B,
    6. Langley SEM
    . Outcome analysis and patient satisfaction following octant transrectal ultrasound-guided prostate biopsy: a prospective study comparing consultant urologist, specialist registrar and nurse practitioner in urology. Prostate Cancer Prostatic Dis. 2004;7(2):122–125pmid:15069422
    OpenUrlCrossRefPubMed
    1. Henderson SO,
    2. Ahern T,
    3. Williams D,
    4. Mailhot T,
    5. Mandavia D
    . Emergency department ultrasound by nurse practitioners. J Am Acad Nurse Pract. 2010;22(7):352–355pmid:20590956
    OpenUrlCrossRefPubMed
    1. Iregui MG,
    2. Prentice D,
    3. Sherman G,
    4. Schallom L,
    5. Sona C,
    6. Kollef MH
    . Physicians’ estimates of cardiac index and intravascular volume based on clinical assessment versus transesophageal Doppler measurements obtained by critical care nurses. Am J Crit Care. 2003;12(4):336–342pmid:12882064
    OpenUrlAbstract/FREE Full Text
    1. Noble VE,
    2. Lamhaut L,
    3. Capp R,
    4. et al
    . Evaluation of a thoracic ultrasound training module for the detection of pneumothorax and pulmonary edema by prehospital physician care providers. BMC Med Educ. 2009;9(3). Available at: http://biomedcentral.com/1472-6920/9/3pmid:19138397
    OpenUrlCrossRefPubMed
  17. ↵
    1. Walcher F,
    2. Weinlich M,
    3. Conrad G,
    4. et al
    . Prehospital ultrasound imaging improves management of abdominal trauma. Br J Surg. 2006;93(2):238–242pmid:16329081
    OpenUrlCrossRefPubMed
  18. ↵
    1. Pearce MS,
    2. Salotti JA,
    3. Little MP,
    4. et al
    . Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499–505pmid:22681860
    OpenUrlCrossRefPubMed
    1. Brenner DJ,
    2. Hall EJ
    . Computed tomography—an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277–2284pmid:18046031
    OpenUrlCrossRefPubMed
    1. Brenner D,
    2. Elliston C,
    3. Hall E,
    4. Berdon W
    . Estimated risks of radiation-induced fatal cancer from pediatric CT. AJR Am J Roentgenol. 2001;176(2):289–296pmid:11159059
    OpenUrlCrossRefPubMed
  21. ↵
    1. Brenner DJ
    . Estimating cancer risks from pediatric CT: going from the qualitative to the quantitative. Pediatr Radiol. 2002;32(4):228–1; discussion 242–244pmid:11956700
    OpenUrlCrossRefPubMed
    1. Brody AS,
    2. Frush DP,
    3. Huda W,
    4. Brent RL,
    5. American Academy of Pediatrics Section on Radiology
    . Radiation risk to children from computed tomography. Pediatrics. 2007;120(3):677–682pmid:17766543
    OpenUrlAbstract/FREE Full Text
    1. Callahan MJ
    . CT dose reduction in practice. Pediatr Radiol. 2011;41(suppl 2):488–492pmid:21847727
    OpenUrlPubMed
    1. Donnelly LF
    . Reducing radiation dose associated with pediatric CT by decreasing unnecessary examinations. AJR Am J Roentgenol. 2005;184(2):655–657pmid:15671393
    OpenUrlCrossRefPubMed
    1. Fazel R,
    2. Krumholz HM,
    3. Wang Y,
    4. et al
    . Exposure to low-dose ionizing radiation from medical imaging procedures. N Engl J Med. 2009;361(9):849–857pmid:19710483
    OpenUrlCrossRefPubMed
    1. Fenton SJ,
    2. Hansen KW,
    3. Meyers RL,
    4. et al
    . CT scan and the pediatric trauma patient—are we overdoing it? J Pediatr Surg. 2004;39(12):1877–1881pmid:15616956
    OpenUrlCrossRefPubMed
    1. Frush DP,
    2. Donnelly LF,
    3. Rosen NS
    . Computed tomography and radiation risks: what pediatric health care providers should know. Pediatrics. 2003;112(4):951–957pmid:14523191
    OpenUrlAbstract/FREE Full Text
    1. Hartin CW Jr,
    2. Jordan JM,
    3. Gemme S,
    4. et al
    . Computed tomography scanning in pediatric trauma: opportunities for performance improvement and radiation safety. J Surg Res. 2013;180(2):226–231pmid:22578856
    OpenUrlCrossRefPubMed
    1. Nickoloff EL,
    2. Alderson PO
    . Radiation exposures to patients from CT: reality, public perception, and policy. AJR Am J Roentgenol. 2001;177(2):285–287pmid:11461846
    OpenUrlCrossRefPubMed
    1. Rajaraman P,
    2. Simpson J,
    3. Neta G,
    4. et al
    . Early life exposure to diagnostic radiation and ultrasound scans and risk of childhood cancer: case-control study. BMJ. 2011;342:d472. doi:10.1136/bmj.d472pmid:21310791
    OpenUrlAbstract/FREE Full Text
  31. ↵
    1. Linet MS,
    2. Kim K-P,
    3. Rajaraman P
    . Children’s exposure to diagnostic medical radiation and cancer risk: epidemiologic and dosimetric considerations. Pediatr Radiol. 2009;39(suppl 1):S4–S26pmid:19083224
    OpenUrlCrossRefPubMed
  32. ↵
    1. Slovis TL
    . Conference on the ALARA (as low as reasonably achievable) concept in pediatric CT: intelligent dose reduction. Pediatr Radiol. 2002;32(4):217–218pmid:11956695
    OpenUrlCrossRefPubMed
  33. ↵
    1. Linton OW,
    2. Mettler FA Jr,
    3. National Council on Radiation Protection and Measurements
    . National conference on dose reduction in CT, with an emphasis on pediatric patients. AJR Am J Roentgenol. 2003;181(2):321–329pmid:12876005
    OpenUrlCrossRefPubMed
  34. ↵
    1. Food and Drug Administration
    . FDA public health notification: reducing radiation risk from computed tomography for pediatric and small adult patients. Pediatr Radiol. 2002;32(4):314–316pmid:11956716
    OpenUrlCrossRefPubMed
  35. ↵
    National Cancer Institute. Radiation risks and pediatric computed tomography (CT): a guide for health care providers. Available at: http://cancer.gov/cancerinfo/causes/radiation-risks-pediatric-ct. Accessed October 26, 2011
  36. ↵
    Marin JR, Abo AM, Arroyo AC, et al. Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Crit Ultrasound J. 2016;8(1):1–83
  37. ↵
    American Board of Pediatrics. Pediatric Emergency Medicine: Subspecialty In-training, Certification, and Maintenance of Certification Examinations. Chapel Hill, NC: American Board of Pediatrics; 2011. Available at: www.abp.org/sites/abp/files/pdf/emer2011.pdf. Accessed February 17, 2015
  38. ↵
    Vieira RL, Hsu D, Nagler J, Chen L, Gallagher R, Levy JA. Pediatric emergency medicine fellow training in ultrasound: consensus educational guidelines. Acad Emerg Med. 2013;20(3):300–306
  39. ↵
    1. Marin JR,
    2. Lewiss RE,
    3. American Academy of Pediatrics; Society of Academic Emergency Medicine; American College of Emergency Physicians; World Interactive Network Focused On Critical UltraSound
    . Technical report: point-of-care ultrasonography by pediatric emergency medicine physicians. Pediatrics. 2015;135(4). Available at: www.pediatrics.org/cgi/content/full/135/4/e1113
  40. ↵
    Cahalan MK, Stewart W, Pearlman A, et al. American Society of Echocardiography and Society of Cardiovascular Anesthesiologists task force guidelines for training in perioperative echocardiography. 2002;15(6):647–652
  41. ↵
    1. American College of Emergency Physicians
    . Emergency ultrasound guidelines. Ann Emerg Med. 2009;53(4):550–570pmid:19303521
    OpenUrlCrossRefPubMed
  42. ↵
    1. Fox JC,
    2. Boysen M,
    3. Gharahbaghian L,
    4. et al
    . Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med. 2011;18(5):477–482pmid:21569167
    OpenUrlCrossRefPubMed
    1. Holmes JF,
    2. Gladman A,
    3. Chang CH
    . Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis. J Pediatr Surg. 2007;42(9):1588–1594pmid:17848254
    OpenUrlCrossRefPubMed
    1. Sola JE,
    2. Cheung MC,
    3. Yang R,
    4. et al
    . Pediatric FAST and elevated liver transaminases: an effective screening tool in blunt abdominal trauma. J Surg Res. 2009;157(1):103–107pmid:19592033
    OpenUrlCrossRefPubMed
    1. Squire BT,
    2. Fox JC,
    3. Anderson C
    . ABSCESS: applied bedside sonography for convenient evaluation of superficial soft tissue infections. Acad Emerg Med. 2005;12(7):601–606pmid:15995090
    OpenUrlCrossRefPubMed
    1. Tayal VS,
    2. Hasan N,
    3. Norton HJ,
    4. Tomaszewski CA
    . The effect of soft-tissue ultrasound on the management of cellulitis in the emergency department. Acad Emerg Med. 2006;13(4):384–388pmid:16531602
    OpenUrlCrossRefPubMed
    1. Sivitz AB,
    2. Lam SHF,
    3. Ramirez-Schrempp D,
    4. Valente JH,
    5. Nagdev AD
    . Effect of bedside ultrasound on management of pediatric soft-tissue infection. J Emerg Med. 2010;39(5):637–643pmid:19665335
    OpenUrlCrossRefPubMed
    1. Iverson K,
    2. Haritos D,
    3. Thomas R,
    4. Kannikeswaran N
    . The effect of bedside ultrasound on diagnosis and management of soft tissue infections in a pediatric ED. Am J Emerg Med. 2012;30(8):1347–1351pmid:22100468
  49. Marin JR, Dean AJ, Bilker WB, Panebianco NL, Brown NJ, Alpern ER. Emergency ultrasound-assisted examination of skin and soft tissue infections in the pediatric emergency department. Acad Emerg Med. 2013;20(6):545–553
    1. Friedman DI,
    2. Forti RJ,
    3. Wall SP,
    4. Crain EF
    . The utility of bedside ultrasound and patient perception in detecting soft tissue foreign bodies in children. Pediatr Emerg Care. 2005;21(8):487–492pmid:16096591
    OpenUrlAbstract/FREE Full Text
    1. Chen L,
    2. Hsiao AL,
    3. Moore CL,
    4. Dziura JD,
    5. Santucci KA
    . Utility of bedside bladder ultrasound before urethral catheterization in young children. Pediatrics. 2005;115(1):108–111pmid:15629989
    OpenUrlCrossRefPubMed
    1. Witt M,
    2. Baumann BM,
    3. McCans K
    . Bladder ultrasound increases catheterization success in pediatric patients. Acad Emerg Med. 2005;12(4):371–374pmid:15805331
    OpenUrlCrossRefPubMed
    1. Randazzo MR,
    2. Snoey ER,
    3. Levitt MA,
    4. Binder K
    . Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med. 2003;10(9):973–977pmid:12957982
    OpenUrlAbstract/FREE Full Text
    1. Pershad J,
    2. Myers S,
    3. Plouman C,
    4. et al
    . Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill patient. Pediatrics. 2004;114(6). Available at: www.pediatrics.org/cgi/content/full/114/6/e667pmid:15545620
    OpenUrlCrossRefPubMed
    1. Longjohn M,
    2. Wan J,
    3. Joshi V,
    4. Pershad J
    . Point-of-care echocardiography by pediatric emergency physicians. Pediatr Emerg Care. 2011;27(8):693–696pmid:21811201
    OpenUrlCrossRefPubMed
    1. Chen L,
    2. Hsiao A,
    3. Langhan M,
    4. Riera A,
    5. Santucci KA
    . Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis. Acad Emerg Med. 2010;17(10):1042–1047pmid:21040104
    OpenUrlCrossRefPubMed
    1. Chen L,
    2. Kim Y,
    3. Santucci KA
    . Use of ultrasound measurement of the inferior vena cava diameter as an objective tool in the assessment of children with clinical dehydration. Acad Emerg Med. 2007;14(10):841–845pmid:17898246
  58. Perera P, Mailhot T, Riley D, Mandavia D. The RUSH exam: Rapid Ultrasound in SHock in the evaluation of the critically ill. Emerg Med Clin North Am. 2010;28(1):29–56, vii
  59. Labovitz AJ, Noble VE, Bierig M, et al. Focused cardiac ultrasound in the emergent setting: a consensus statement of the American Society of Echocardiography and American College of Emergency Physicians. J Am Soc Echocardiogr. 2010:23(12);1225–1230
    1. Kendall JL,
    2. Shimp RJ
    . Performance and interpretation of focused right upper quadrant ultrasound by emergency physicians. J Emerg Med. 2001;21(1):7–13pmid:11399381
    OpenUrlCrossRefPubMed
    1. Blaivas M,
    2. Harwood RA,
    3. Lambert MJ
    . Decreasing length of stay with emergency ultrasound examination of the gallbladder. Acad Emerg Med. 1999;6(10):1020–1023pmid:10530660
    OpenUrlCrossRefPubMed
    1. Freeman K,
    2. Dewitz A,
    3. Baker WE
    . Ultrasound-guided hip arthrocentesis in the ED. Am J Emerg Med. 2007;25(1):80–86pmid:17157689
    OpenUrlCrossRefPubMed
    1. LaRocco BG,
    2. Zlupko G,
    3. Sierzenski P
    . Ultrasound diagnosis of quadriceps tendon rupture. J Emerg Med. 2008;35(3):293–295pmid:17976823
    OpenUrlCrossRefPubMed
    1. Sisson C,
    2. Nagdev A,
    3. Tirado A,
    4. Murphy M,
    5. Suner S
    . Ultrasound diagnosis of traumatic partial triceps tendon tear in the emergency department. J Emerg Med. 2011;40(4):436–438pmid:19201135
    OpenUrlCrossRefPubMed
    1. Weinberg ER,
    2. Tunik MG,
    3. Tsung JW
    . Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010;41(8):862–868pmid:20466368
    OpenUrlCrossRefPubMed
    1. Durston W,
    2. Swartzentruber R
    . Ultrasound guided reduction of pediatric forearm fractures in the ED. Am J Emerg Med. 2000;18(1):72–77pmid:10674538
    OpenUrlCrossRefPubMed
    1. Patel DD,
    2. Blumberg SM,
    3. Crain EF
    . The utility of bedside ultrasonography in identifying fractures and guiding fracture reduction in children. Pediatr Emerg Care. 2009;25(4):221–225pmid:19382318
    OpenUrlCrossRefPubMed
    1. Chen L,
    2. Kim Y,
    3. Moore CL
    . Diagnosis and guided reduction of forearm fractures in children using bedside ultrasound. Pediatr Emerg Care. 2007;23(8):528–531pmid:17726410
    OpenUrlCrossRefPubMed
    1. Cross KP,
    2. Warkentine FH,
    3. Kim IK,
    4. Gracely E,
    5. Paul RI
    . Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department. Acad Emerg Med. 2010;17(7):687–693pmid:20653581
    OpenUrlCrossRefPubMed
    1. Chien M,
    2. Bulloch B,
    3. Garcia-Filion P,
    4. Youssfi M,
    5. Shrader MW,
    6. Segal LS
    . Bedside ultrasound in the diagnosis of pediatric clavicle fractures. Pediatr Emerg Care. 2011;27(11):1038–1041pmid:22068064
    OpenUrlCrossRefPubMed
    1. Chaar-Alvarez FM,
    2. Warkentine F,
    3. Cross K,
    4. Herr S,
    5. Paul RI
    . Bedside ultrasound diagnosis of nonangulated distal forearm fractures in the pediatric emergency department. Pediatr Emerg Care. 2011;27(11):1027–1032pmid:22068062
    OpenUrlCrossRefPubMed
    1. Ramirez-Schrempp D,
    2. Vinci RJ,
    3. Liteplo AS
    . Bedside ultrasound in the diagnosis of skull fractures in the pediatric emergency department. Pediatr Emerg Care. 2011;27(4):312–314pmid:21467882
    OpenUrlAbstract/FREE Full Text
    1. Rabiner JE,
    2. Friedman LM,
    3. Khine H,
    4. Avner JR,
    5. Tsung JW
    . Accuracy of point-of-care ultrasound for diagnosis of skull fractures in children. Pediatrics. 2013;131(6). Available at: www.pediatrics.org/cgi/content/full/131/6/e1757pmid:23690519
    OpenUrlCrossRefPubMed
    1. Vieira RL,
    2. Levy JA
    . Bedside ultrasonography to identify hip effusions in pediatric patients. Ann Emerg Med. 2010;55(3):284–289pmid:19695738
    OpenUrlCrossRefPubMed
    1. Shah VP,
    2. Tunik MG,
    3. Tsung JW
    . Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults. JAMA Pediatr. 2013;167(2):119–125pmid:23229753
    OpenUrlCrossRefPubMed
    1. Theodoro D,
    2. Blaivas M,
    3. Duggal S,
    4. Snyder G,
    5. Lucas M
    . Real-time B-mode ultrasound in the ED saves time in the diagnosis of deep vein thrombosis (DVT). Am J Emerg Med. 2004;22(3):197–200pmid:15138956
    OpenUrlCrossRefPubMed
    1. Magazzini S,
    2. Vanni S,
    3. Toccafondi S,
    4. et al
    . Duplex ultrasound in the emergency department for the diagnostic management of clinically suspected deep vein thrombosis. Acad Emerg Med. 2007;14(3):216–220pmid:17264203
    OpenUrlCrossRefPubMed
    1. Jolly BT,
    2. Massarin E,
    3. Pigman EC
    . Color Doppler ultrasonography by emergency physicians for the diagnosis of acute deep venous thrombosis. Acad Emerg Med. 1997;4(2):129–132pmid:9043540
    OpenUrlCrossRefPubMed
    1. Blaivas M,
    2. Theodoro D,
    3. Sierzenski PR
    . A study of bedside ocular ultrasonography in the emergency department. Acad Emerg Med. 2002;9(8):791–799pmid:12153883
    OpenUrlCrossRefPubMed
    1. Tayal VS,
    2. Neulander M,
    3. Norton HJ,
    4. Foster T,
    5. Saunders T,
    6. Blaivas M
    . Emergency department sonographic measurement of optic nerve sheath diameter to detect findings of increased intracranial pressure in adult head injury patients. Ann Emerg Med. 2007;49(4):508–514pmid:16997419
    OpenUrlCrossRefPubMed
    1. Yoonessi R,
    2. Hussain A,
    3. Jang TB
    . Bedside ocular ultrasound for the detection of retinal detachment in the emergency department. Acad Emerg Med. 2010;17(9):913–917pmid:20836770
    OpenUrlCrossRefPubMed
    1. Riera A,
    2. Hsiao AL,
    3. Langhan ML,
    4. Goodman TR,
    5. Chen L
    . Diagnosis of intussusception by physician novice sonographers in the emergency department. Ann Emerg Med. 2012;60(3):264–268pmid:22424652
  83. Sivitz AB, Tejani C, Cohen SG. Evaluation of hypertrophic pyloric stenosis by pediatric emergency physician sonography. Acad Emerg Med. 2013:20(7):646–651
    1. Fox JC,
    2. Solley M,
    3. Anderson CL,
    4. Zlidenny A,
    5. Lahham S,
    6. Maasumi K
    . Prospective evaluation of emergency physician performed bedside ultrasound to detect acute appendicitis. Eur J Emerg Med. 2008;15(2):80–85pmid:18446069
    OpenUrlCrossRefPubMed
    1. McRae A,
    2. Murray H,
    3. Edmonds M
    . Diagnostic accuracy and clinical utility of emergency department targeted ultrasonography in the evaluation of first-trimester pelvic pain and bleeding: a systematic review. CJEM. 2009;11(4):355–364pmid:19594975
    OpenUrlCrossRefPubMed
    1. Blaivas M,
    2. Sierzenski P,
    3. Plecque D,
    4. Lambert M
    . Do emergency physicians save time when locating a live intrauterine pregnancy with bedside ultrasonography? Acad Emerg Med. 2000;7(9):988–993pmid:11043992
    OpenUrlCrossRefPubMed
    1. Stein JC,
    2. Wang R,
    3. Adler N,
    4. et al
    . Emergency physician ultrasonography for evaluating patients at risk for ectopic pregnancy: a meta-analysis. Ann Emerg Med. 2010;56(6):674–683pmid:20828874
    OpenUrlCrossRefPubMed
    1. Randolph AG,
    2. Cook DJ,
    3. Gonzales CA,
    4. Pribble CG
    . Ultrasound guidance for placement of central venous catheters: a meta-analysis of the literature. Crit Care Med. 1996;24(12):2053–2058pmid:8968276
    OpenUrlCrossRefPubMed
    1. Miller AH,
    2. Roth BA,
    3. Mills TJ,
    4. Woody JR,
    5. Longmoor CE,
    6. Foster B
    . Ultrasound guidance versus the landmark technique for the placement of central venous catheters in the emergency department. Acad Emerg Med. 2002;9(8):800–805pmid:12153885
    OpenUrlCrossRefPubMed
    1. Keyes LE,
    2. Frazee BW,
    3. Snoey ER,
    4. Simon BC,
    5. Christy D
    . Ultrasound-guided brachial and basilic vein cannulation in emergency department patients with difficult intravenous access. Ann Emerg Med. 1999;34(6):711–714pmid:10577399
    OpenUrlCrossRefPubMed
    1. Doniger SJ,
    2. Ishimine P,
    3. Fox JC,
    4. Kanegaye JT
    . Randomized controlled trial of ultrasound-guided peripheral intravenous catheter placement versus traditional techniques in difficult-access pediatric patients. Pediatr Emerg Care. 2009;25(3):154–159pmid:19262420
    OpenUrlCrossRefPubMed
    1. Ferre RM,
    2. Sweeney TW
    . Emergency physicians can easily obtain ultrasound images of anatomical landmarks relevant to lumbar puncture. Am J Emerg Med. 2007;25(3):291–296pmid:17349903
  93. Nomura JT, Leech SJ, Shenbagamurthi S, et al. A randomized controlled trial of ultrasound-assisted lumbar puncture. J Ultrasound Med. 2007;26(10):1341–1348
    1. Liebmann O,
    2. Price D,
    3. Mills C,
    4. et al
    . Feasibility of forearm ultrasonography-guided nerve blocks of the radial, ulnar, and median nerves for hand procedures in the emergency department. Ann Emerg Med. 2006;48(5):558–562pmid:17052557
    OpenUrlCrossRefPubMed
    1. Stone MB,
    2. Wang R,
    3. Price DD
    . Ultrasound-guided supraclavicular brachial plexus nerve block vs procedural sedation for the treatment of upper extremity emergencies. Am J Emerg Med. 2008;26(6):706–710pmid:18606327
    OpenUrlCrossRefPubMed
    1. Shiver S,
    2. Blaivas M,
    3. Lyon M
    . A prospective comparison of ultrasound-guided and blindly placed radial arterial catheters. Acad Emerg Med. 2006;13(12):1275–1279pmid:17079789
    OpenUrlCrossRefPubMed
    1. Plummer D,
    2. Brunette D,
    3. Asinger R,
    4. Ruiz E,
    5. D P
    . Emergency department echocardiography improves outcome in penetrating cardiac injury. Ann Emerg Med. 1992;21(6):709–712pmid:1590612
    OpenUrlCrossRefPubMed
    1. Gaspari RJ,
    2. Horst K
    . Emergency ultrasound and urinalysis in the evaluation of flank pain. Acad Emerg Med. 2005;12(12):1180–1184pmid:16282510
    OpenUrlCrossRefPubMed
    1. Watkins S,
    2. Bowra J,
    3. Sharma P,
    4. Holdgate A,
    5. Giles A,
    6. Campbell L
    . Validation of emergency physician ultrasound in diagnosing hydronephrosis in ureteric colic. Emerg Med Australas. 2007;19(3):188–195pmid:17564683
    OpenUrlCrossRefPubMed
    1. Burnside PR,
    2. Brown MD,
    3. Kline JA
    . Systematic review of emergency physician-performed ultrasonography for lower-extremity deep vein thrombosis. Acad Emerg Med. 2008;15(6):493–498pmid:18616433
    OpenUrlCrossRefPubMed
    1. Adhikari S,
    2. Blaivas M,
    3. Lyon M
    . Diagnosis and management of ectopic pregnancy using bedside transvaginal ultrasonography in the ED: a 2-year experience. Am J Emerg Med. 2007;25(6):591–596pmid:17606080
    OpenUrlCrossRefPubMed
    1. Adhikari S,
    2. Blaivas M,
    3. Lyon M
    . Role of bedside transvaginal ultrasonography in the diagnosis of tubo-ovarian abscess in the emergency department. J Emerg Med. 2008;34(4):429–433pmid:18242924
    OpenUrlCrossRefPubMed
    1. Blaivas M,
    2. Sierzenski P,
    3. Lambert M
    . Emergency evaluation of patients presenting with acute scrotum using bedside ultrasonography. Acad Emerg Med. 2001;8(1):90–93pmid:11136159
    OpenUrlCrossRefPubMed
    1. Nazeer SR,
    2. Dewbre H,
    3. Miller AH
    . Ultrasound-assisted paracentesis performed by emergency physicians vs the traditional technique: a prospective, randomized study. Am J Emerg Med. 2005;23(3):363–367pmid:15915415
    OpenUrlCrossRefPubMed
  105. ↵
    1. Wiler JL,
    2. Costantino TG,
    3. Filippone L,
    4. Satz W
    . Ultrasound in emergency medicine. J Emerg Med. 2010;39(1):76–82
  106. ↵
    Resnick J, Hoffenberg S, Tayal V, Dickman E. Ultrasound coding and reimbursement update 2009. Emergency Ultrasound Section. American College of Emergency Physicians. Available at: www.acep.org/content.aspx?id=32182. Accessed March 26, 2013, August 25, 2014
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Pediatrics
Vol. 135, Issue 4
1 Apr 2015
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Point-of-Care Ultrasonography by Pediatric Emergency Medicine Physicians
AMERICAN ACADEMY OF PEDIATRICS, Committee on Pediatric Emergency Medicine, SOCIETY FOR ACADEMIC EMERGENCY MEDICINE, Academy of Emergency Ultrasound, AMERICAN COLLEGE OF EMERGENCY PHYSICIANS, Pediatric Emergency Medicine Committee, WORLD INTERACTIVE NETWORK FOCUSED ON CRITICAL ULTRASOUND
Pediatrics Apr 2015, 135 (4) e1097-e1104; DOI: 10.1542/peds.2015-0342
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