Department of Anesthesiology and Critical Care Medicine, Children's Hospital of Philadelphia and Perelman School of Medicine, Philadelphia, PA, USA.
Division of Pediatrics and Neonatal Critical Care, Antoine Béclère Medical Center, APHP, South Paris University Hospitals, Paris, France.
Eur J Pediatr. 2022 Apr;181(4):1449-1457. doi: 10.1007/s00431-021-04324-4. Epub 2021 Nov 30.
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.
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.
• 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.
• 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.
床边即时超声（POCUS）指的是治疗医生直接使用便携式超声（US）应用程序进行诊断或程序指导。它正在全球范围内迅速被传统的非成像医学专业采用。最近，欧洲儿科和新生儿重症监护协会（ESPNIC）的 POCUS 工作组发布了关于危重新生儿和儿童 POCUS 的国际循证指南。目前，没有针对其在临床实践中的实施的标准化国家或国际指南，甚至没有监测质量保证的培训课程。此外，其各种临床应用中的 POCUS 能力衡量也没有定义或方法。
希波克拉底誓言表明，医疗提供者不得伤害他们的患者。在我们继续努力维护这一价值观的过程中，寻求解决临床问题的提供者必须经常权衡干预的益处与对患者造成伤害的风险。指导诊断和医疗管理的技术在评估对患者可能存在的风险时提出了独特的考虑因素。风险经常超出患者范围，影响到提供者和他们所在的医疗机构。POCUS 是一种新兴技术，越来越多地应用于各种儿科临床专业的患者护理中。临床同事和监管机构对 POCUS 的适当使用和监督提出了担忧。我们提出了一个评估儿科 POCUS 使用风险的框架，并提出了降低风险的方法，以优化患者、提供者和医疗机构的安全性和结果。
传统的非成像儿科专业医生为诊断和程序指导使用即时超声（POCUS）的情况正在迅速增加。
尽管有关于其适应症的国际指南，但目前尚无关于其在临床实践中实施的标准化指南。
虽然尚未定义儿科专业特定的 POCUS 课程和培训到能力标准，但当存在计划基础设施要素时，POCUS 最有可能成功地融入临床护理。
风险评估是一个前瞻性的过程，需要一种不精确的计算方法，该方法整合了对技术、提供者和医疗保健提供背景的考虑。医疗法律方面的考虑因国家而异，并且经常变化，这要求提供者和机构了解当地的监管要求和法律框架，以减轻 POCUS 的潜在风险。
