Radiologists should support non-radiologist point-of-care ultrasonography in children: a case for involvement and collaboration

Andronikou, Savvas; Otero, Hansel J.; Bélard, Sabine; Heuvelings, Charlotte C.; Ruby, Lisa; Grobusch, Martin P.

doi:10.1007/s00247-021-05185-7

Cited by 7 publications

(12 citation statements)

References 19 publications

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“…Both Györgyi et al [2] and Andronikou et al [1] agreed with our position that a wide range of trained users are currently offering POCUS. We also recognise that much of the literature they cited on the effectiveness of non-radiologist POCUS recognises improvements in workload efficiency, reducing delays, potential cost efficiencies and consequences for overall health care costs [1].…”

supporting

confidence: 83%

“…Dear Editors, We read with interest the letters of Andronikou et al [1] and Györgyi et al [2] regarding the European Society of Paediatric Radiology (ESPR) position statement on non-radiologist point-of-care ultrasound (POCUS) [3].…”

mentioning

confidence: 99%

“…We encourage practitioners not to confuse availability with diagnostic accuracy. In their case study of lung US, only one of the papers put forwards by Andronikou et al [1] discussed the diagnostic accuracy of POCUS [7]. In that study, 12 of 34 people with coronavirus disease 2019 (COVID-19), the disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), had CT performed to compare against lung US.…”

mentioning

confidence: 99%

“…Andronikou et al [1] also recognised that it is the limited experience rather than status of US practitioners that can generate errors. We could not agree more: clearly many radiologists make errors, but they do so in a regulated environment that highlights rather than hides errors.…”

mentioning

confidence: 99%

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Point-of-care ultrasound: reply to Andronikou et al. and Györgyi et al.

et al. 2021

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supporting

confidence: 83%

mentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Point-of-care ultrasound: reply to Andronikou et al. and Györgyi et al.

et al. 2021

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“…Representatives from the European Society of Emergency Pediatrics (ESEP), the Ultrasound Section of the European Society for Emergency Medicine (EUSEM), and the Pediatric Emergency Medicine Point-of Care Ultrasound (P2) “respectfully disagree with the conclusions [of the ESPR statement], especially the need for further oversight from our radiology colleagues.”[ 22 ] While the ESPR position statement recommends a well thought-out curriculum for each clinical specialty wishing to perform POCUS and lists European credentialing/certification methods for undergraduates, general radiology training, and radiology subspecialization, it should be noted that these are not requirements for licensing and performing pediatric ultrasound as a radiologist in Europe [ 20 ]. The “need for credentialing non-radiologists who want to become involved in non-radiologist point-of-care [ultrasound]” should be balanced by what is expected of radiologists themselves [ 23 ]. Similarly, a perspective published by adult and pediatric POCUS experts suggest that “if these statements [by the ECRI] are used to guide the governance of POCUS use in pediatric intensive care units (PICUs), the resulting policies may be overly restrictive of a practice that actually has several potential benefits” and that, within the ECRI report, “no objective data were presented” as a basis for concerns [ 24 ].…”

Section: Pocus Risk: Current Concernsmentioning

confidence: 99%

Establishing a risk assessment framework for point-of-care ultrasound

Conlon

Yousef²,

Mayordomo-Colunga

et al. 2021

Eur J Pediatr

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Point-of-care ultrasound (POCUS) refers to the use of portable ultrasound (US) applications at the bedside, performed directly by the treating physician, for either diagnostic or procedure guidance purposes. It is being rapidly adopted by traditionally non-imaging medical specialties across the globe. Recent international evidence-based guidelines on POCUS for critically ill neonates and children were issued by the POCUS Working Group of the European Society of Pediatric and Neonatal Intensive Care (ESPNIC). Currently there are no standardized national or international guidelines for its implementation into clinical practice or even the training curriculum to monitor quality assurance. Further, there are no definitions or methods of POCUS competency measurement across its varied clinical applications.Conclusion: The Hippocratic Oath suggests medical providers do no harm to their patients. In our continued quest to uphold this value, providers seeking solutions to clinical problems must often weigh the benefit of an intervention with the risk of harm to the patient. Technologies to guide diagnosis and medical management present unique considerations when assessing possible risk to the patient. Frequently risk extends beyond the patient and impacts providers and the institutions in which they practice. POCUS is an emerging technology increasingly incorporated in the care of children across varied clinical specialties. Concerns have been raised by clinical colleagues and regulatory agencies regarding appropriate POCUS use and oversight. We present a framework for assessing the risk of POCUS use in pediatrics and suggest methods of mitigating risk to optimize safety and outcomes for patients, providers, and institutions. What is Known: • The use POCUS by traditionally non-imaging pediatric specialty physicians for both diagnostic and procedural guidance is rapidly increasing. • Although there are international guidelines for its indications, currently there is no standardized guidance on its implementation in clinical practice. What is New: • Although standards for pediatric specialty-specific POCUS curriculum and training to competency have not been defined, POCUS is likely to be most successfully incorporated in clinical care when programmatic infrastructural elements are present. • Risk assessment is a forward-thinking process and requires an imprecise calculus that integrates considerations of the technology, the provider, and the context in which medical care is delivered. Medicolegal considerations vary across countries and frequently change, requiring providers and institutions to understand local regulatory requirements and legal frameworks to mitigate the potential risks of POCUS.

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Global survey on point-of-care ultrasound (pocus) use in child surgery

Naidoo,

Salim,

Jackson

et al. 2024

Pediatr Surg Int

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Purpose To undertake a global assessment of existing ultrasound practices, barriers to access, point-of-care ultrasound (POCUS) training pathways, and the perceived clinical utility of POCUS in Child Surgery. Methods An electronic survey was disseminated via the GICS (Global Initiative of Children’s Surgery) network. 247 anonymized responses from 48 countries were collated. 71.3% (176/247) worked in child surgery. Results Ultrasound was critical to practice with 84% (147/176) of requesting one daily or multiple times per week. Only 10% (17/176) could access emergency ultrasound < 1 h from request. The main barrier was a lack of trained personnel. HIC surgeons were more likely to have ultrasound training (24/29; 82.8%) compared with LMICs (74/147; 50.3%) (p = .001319; CI 95%). Self-perceived POCUS competence was associated with regularity of POCUS use (p < 0.001; CI 95%). Those who already practice POCUS most commonly use it for trauma, intussusception, and ultrasound-guided procedures. Majority (90%; 159/176) of child surgeons would attend formal POCUS training if available. Conclusions Ultrasound is critically important in children’s surgery globally, however, many surgeons experience barriers to timely access. There is a strong interest in learning POCUS for relevant pediatric surgical applications. Further research is needed to evaluate the best methods of training, accreditation, and governance.

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Radiologists should support non-radiologist point-of-care ultrasonography in children: a case for involvement and collaboration

Cited by 7 publications

References 19 publications

Point-of-care ultrasound: reply to Andronikou et al. and Györgyi et al.

Point-of-care ultrasound: reply to Andronikou et al. and Györgyi et al.

Establishing a risk assessment framework for point-of-care ultrasound

Global survey on point-of-care ultrasound (pocus) use in child surgery

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