Clinical Applications of Point-of-Care and Diagnostic Transcranial Doppler in the Pediatric Acute Care Setting: A Scoping Review.

Transcranial Doppler (TCD) is increasingly used in pediatric acute care with emerging point-of-care ultrasound (POCUS) applications. However, no standardized definition distinguishes POCUS TCD from diagnostic/consultative TCD. This scoping review aims to (1) examine how the terminology "POCUS TCD" is used in pediatric literature, (2) describe physiologic indications driving TCD use in pediatric acute care settings, and (3) compare contexts of performance and operational characteristics across these indications. A comprehensive scoping review was conducted following published guidelines. Databases were searched from inception to June 2024 for studies addressing TCD use in children (≤ 18 years) in emergency departments, inpatient services, or intensive care units. Full-text eligibility and data extraction were performed in duplicate by independent reviewers. Of 4,066 screened studies, 660 full texts were assessed, and 307 studies met eligibility criteria (258 original studies and 49 reviews, guidelines, or surveys). The term "POCUS TCD" was mentioned in only 3% of original studies and 26% of included reviews and guidelines, which were mostly published after 2018. Eleven physiologic indications for TCD use were identified, and specific subtypes of context of use emerged. TCD operational characteristics varied widely and were often incompletely reported. However, notable differences were observed across physiologic indications, particularly in TCD extent, operator type, and use of point-of-care machines. The terminology "POCUS TCD" is infrequently used in current pediatric research, and most studies do not specify the type of TCD performed or intended. Significant differences in the context of performance and operational characteristics across physiologic indications suggest the coexistence of distinct forms of TCD in current clinical practice despite the lack of explicit distinction between POCUS and diagnostic/consultative TCD. Standardizing terminology and improving reporting of operational contexts in future research will be essential to support safe and effective clinical integration of TCD in pediatric critical care.