Diagnostic Applications of

P o i n t - o f - C a re U l t r a s o u n d i n
Pediatric Emergency Medicine
a,b, a,b
Margaret Lin-Martore, MD *, Aaron E. Kornblith, MD

KEYWORDS
 Pediatrics  Emergency medicine  Point-of-care ultrasound  Diagnostic

KEY POINTS
 Point-of-care ultrasound is an essential part of pediatric emergency training and practice.
 Point-of-care ultrasound can decrease lengths of stay, decrease radiation exposure, and
improve patient satisfaction.
 There are a variety of different diagnostic applications for point-of-care ultrasound in pe-
diatric emergency medicine, which have varying levels of evidence.
 Understanding the evidence and techniques for point-of-care ultrasound applications,
can assist providers in using point-of-care ultrasound in their clinical practice.

INTRODUCTION

Point-of-care ultrasound (POCUS) is performed by the clinician at the bedside and is a

growing skill that improves diagnostic accuracy,1,2 decreases emergency department
lengths of stay,3–6 and improves overall patient satisfaction.7,8 POCUS is especially
important to consider in the pediatric population because children are at higher risk
for malignancy from ionizing radiation than adult patients.9 Furthermore, POCUS
can be easily accessible, and imaging resolution in children is often adequate owing
to smaller body habitus. POCUS offers a rapid and dynamic assessment for life-
threatening conditions and, therefore, has been recently integrated into the training
of pediatric emergency medicine (PEM) fellows and as part of PEM practice.10,11
More recently, guidelines for specific ultrasound applications for PEM fellows and fac-
ulty have been published.12–14
In this review, we discuss the most promising POCUS diagnostic applications per
expert consensus.12,13 We discuss the following applications: Extended-Focused

a
Department of Emergency Medicine, University of California, San Francisco, 550 16th Street,
Box 0632, San Francisco, CA 94143, USA; b Department of Pediatrics, University of California,
San Francisco, 550 16th Street, Box 0632, San Francisco, CA 94143, USA
* Corresponding author. Department of Emergency Medicine, University of California, San
Francisco, 550 16th Street, Box 0632, San Francisco, CA 94143.
E-mail address: [email protected]

Emerg Med Clin N Am 39 (2021) 509–527

https://doi.org/10.1016/j.emc.2021.04.005 emed.theclinics.com
0733-8627/21/ª 2021 Elsevier Inc. All rights reserved.

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510 Lin-Martore & Kornblith

Assessment with Sonography in Trauma, cardiac, inferior vena cava (IVC), bladder,
renal, gallbladder and biliary, pelvic obstetrics, pelvic gynecology, and pediatric
abdomen—intussusception, appendicitis, and pyloric stenosis, pulmonary, ocular,
and testicular. A companion review on the procedural applications of POCUS in
PEM discusses further applications focusing on procedural applications.

DISCUSSION OF POINT-OF-CARE ULTRASOUND APPLICATIONS

Pediatric Focused Assessment with Sonography for Trauma and Extended-Focused
Assessment with Sonography for Trauma
Focused Assessment with Sonography for Trauma (FAST) is a series of thoracoabdo-
minal ultrasound views performed in conjunction with the primary trauma survey to
rapidly identify pericardial, plural, and peritoneal free fluid (hemorrhage). FAST has
been integrated into the routine care of the injured adult15 and is associated with
improved patient outcomes.16 However, the literature base, diagnostic accuracy,
and usefulness of FAST in children with blunt torso trauma are inconsistent and
lead to variable practice patterns. A single-center randomized trial of FAST compared
with usual practice showed no decrease in computed tomography (CT) scan use.17
However, other reports suggest that FAST integrated into routine care can aid in the
diagnosis and screening of children with blunt trauma, including the FAST-
Enhanced physical examination.18
FAST is performed with a low-frequency transducer in 3 abdominal ultrasound
views, including the right upper quadrant (Figs. 1 and 2), left upper quadrant, and
suprapubic views, as well as at least 1 pericardial view, subxiphoid or parasternal
long axis. The right upper quadrant view is most sensitive in older children, whereas
the suprapubic view may be more sensitive in prepubertal children. Regardless,
each view requires a careful inspection for anechoic free fluid by performing a thor-
ough sweep of pediatric-specific critical anatomic landmarks. On abdominal upper
quadrant views, pleural effusion (hemothorax) is recognized as free fluid or the lack
of mirror image artifact. Similarly, intra-abdominal hemorrhage is identified by inspect-
ing each of the following anatomic spaces: hepatorenal, splenorenal, inferior dia-
phragmatic recess, inferior liver edge, and posterior bladder. To further improve the
accuracy of the study, providers may consider performing FAST serially. Extended-
FAST includes evaluating pneumothorax, which includes pleural sliding using a
high-frequency transducer between air-dependent rib spaces on both thoracic

Fig. 1. Pediatric FAST with anechoic fluid collection located between the hepatorenal junc-
tion of the right upper quadrant view.

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 Diagnostic Applications of Pediatric Emergency POCUS 511

Fig. 2. Pediatric FAST with mirror image artifact at the interface of the liver and the dia-
phragm. This finding suggests the patient does not have hemothorax.

spaces. In younger children, traumatic pneumothorax is a rare finding, but the provider
could evaluate the thorax for pulmonary contusion as represented by asymmetric or
focal B-lines on pulmonary evaluation.

Pediatric Cardiac and Inferior Vena Cava

Focused cardiac ultrasound (FOCUS) seeks to identify common and life-threatening
pediatric disease processes using a directed evaluation of the cardiac structures.
The FOCUS does not supplant comprehensive echocardiography but offers a rapid
bedside assessment for pertinent and life-threatening disease processes. The litera-
ture on FOCUS in children is limited, but in conjunction with adult patient literature, pe-
diatric FOCUS shows usefulness for diagnosing pericardial effusion and impending
cardiac tamponade, categorizing global cardiac systolic function, assessing intravas-
cular volume status, and dynamically gauging physiologic responses to acute thera-
pies and interventions including those offered for shock and cardiac arrest.19 The
standard FOCUS views are performed with a low-frequency phased array transducer
and include the subxiphoid, parasternal long axis, parasternal short axis, apical four-
chamber, and IVC from the subxiphoid longitudinal plane.
A FOCUS assessment for cardiac arrest should include at least 2 cardiac views.
However, it can be challenging to identify a heart in asystole. The use of agitated saline
intravenously may improve the yield in identifying the right side of the heart. Pericardial
effusion is best identified in the subxiphoid or parasternal long axis views. The most
common pericardial effusion mimics are the nondependent anterior pericardial fat
pad and pleural effusions, which do not track between the heart and descending
thoracic aorta (Fig. 3). If a pericardial effusion is identified, FOCUS can be used for
further assessment for impending cardiac tamponade using dynamic parameters,
including IVC assessment. IVC plethora suggests impending or concurrent pericardial
tamponade. Each FOCUS view contributes to the cardiac functional assessment,
including the global assessment of systolic function. Global left ventricular function
can be estimated as usual, moderate, or severely decreased. Metrics, such as the
E-point septal separation, have shown promise in adult FOCUS, but are not confirmed
in children. Foreshortening may distort the typical appearance of the left ventricle
,leading to inaccurate assessments. Dynamic assessment of the IVC can be per-
formed and monitored through respiratory variation. Early literature suggests the
IVC/aortic ratio may be a more objective cutoff for volume assessment.20 A cutoff of

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512 Lin-Martore & Kornblith

Fig. 3. Cardiac POCUS with a parasternal long axis view shown with pericardial and pleural
effusions. The anechoic free fluid tracking between the descending thoracic aorta (red dot)
and myocardium is pericardial effusion. In contrast, the anechoic free fluid tracking deflect-
ing laterally to the descending thoracic aorta is pleural effusion.

IVC/aorta ratio of less than 0.8 has been suggested for assessment of pediatric dehy-
dration; however, the accuracy of this cutoff as well as of POCUS IVC/aorta ratio for
assessment of pediatric dehydration is still under debate21–25 FOCUS performed
dynamically and in real-time may alter therapeutics intervention; for example, if the
IVC remains collapsible during initial emergency resuscitation, the provider may
choose to give intravenous volume over starting a vasopressor agent.

Bladder
One of the first PEM POCUS applications studied and commonly used in the pediatric
emergency department is measuring the bladder’s size before catheterization in chil-
dren. A bladder index (defined as a product of the anteroposterior and the transverse
diameters) of 2.4 cm2 or greater predicts success for urinary catheterization in children
less than 2 years of age. Furthermore, using POCUS to measure bladder volume helps
to avoid repeat catheterization and increases caregiver satisfaction.26–28 A POCUS for
bladder volume also decreases time to radiology-performed transabdominal pelvic
ultrasound.29
Typically, a low-frequency probe (curvilinear or phased array) is fanned while posi-
tioned over the pelvis to examine the bladder in both transverse and sagittal views
(Figs. 4 and 5). Measurements can be taken of the bladder in different dimensions
to calculate an estimated bladder volume.

Renal
POCUS in adult patients has been shown to have modest diagnostic accuracy for the
diagnosis of nephrolithiasis.30 However, the use of POCUS for pediatric renal pathol-
ogy such as obstructive uropathy remains an area of debate. Studies have shown that
radiology-performed ultrasound is not as accurate as a CT scan for diagnosing pedi-
atric urolithiasis.31,32 However, there are noted benefits of ultrasound over a CT scan,
including the lack of ionizing radiation. Thus, there is practice-dependent variation in
imaging for renal pathology.
There are case reports of POCUS being used in pediatric and adolescent patients to
identify urolithiasis and avoid CT radiation.33–35 Still, more research is required to
assess the accuracy of POCUS for this use in children and adolescents.

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 Diagnostic Applications of Pediatric Emergency POCUS 513

Fig. 4. Transverse POCUS view of bladder and volume assessment.

When used for diagnosing nephrolithiasis, ultrasound is typically used to identify

secondary signs, such as hydronephrosis, which is demonstrated by dilating the renal
collecting system rather than visualizing the stone itself (Figs. 6 and 7). Often, a stone
cannot be visualized on ultrasound, although occasionally a twinkling artifact may be
noted or the lack of ureteral jet, which can indicate a stone.33–35 Additionally, case re-
ports exist with POCUS being used to diagnose renal infections36 and other
pathology.37
Typically, a low-frequency probe (curvilinear or phased array) is positioned in the
midaxillary region to examine the kidney in both a longitudinal and transverse view.
The left kidney is more cephalad and posterior compared with the right kidney. The
spleen provides a smaller acoustic window compared with the liver, which can lead
to more difficult visualization, and tilting the probe in between the rib spaces or having
patients take a deep breath to depress the diaphragm may help to improve
visualization.

Gallbladder and Biliary

Although biliary pathology is overall rare in children, the incidence of cholecystitis is
rising in the setting of the obesity epidemic.38 A systematic review of adult patients
showed the pooled estimates for sensitivity and specificity for POCUS for

Fig. 5. Longitudinal POCUS view of bladder and volume assessment.

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514 Lin-Martore & Kornblith

Fig. 6. POCUS image of kidney with hydronephrosis.

cholelithiasis were high: 89.8% (95% confidence interval [CI], 86.4%–92.5%) and
88.0% (95% CI, 83.7%–91.4%), respectively.39 There are case reports of POCUS im-
aging being used to diagnose cholelithiasis in pediatric patients as young as neo-
nates.40,41 However, data on its diagnostic accuracy in the pediatric population are
lacking.
A low-frequency probe is used to perform various approaches to image the gall-
bladder, including the subcostal sweep (where the probe is moved along the right
costal margin from medial to lateral), the lateral approach (where the probe is placed
laterally on the upper right abdomen similar to a FAST approach, but then tilted ante-
riorly to view the gallbladder), or the X minus 7 approach (where the probe is placed
either 7 cm to the right of the xiphoid process or at the midclavicular line in smaller
patients)41,42 to visualize the gallbladder. The gallbladder can then be assessed for
hyperechoic stones with shadowing and biliary sludge (Figs. 8 and 9). The anterior
wall thickness and common bile duct can also be measured. Standard measure-
ments are typically derived from adult measurements (3 mm for gallbladder wall
for adults and 4 mm common bile duct for adults <40 years old) as standard mea-
surements for gallbladder/biliary POCUS for pediatric and neonatal patients are un-
clear. Secondary signs of inflammation or infection include pericholecystic fluid and
Murphy’s sign.

Fig. 7. POCUS image of kidney without hydronephrosis (contralateral kidney in same pa-
tient as Fig. 6) for comparison.

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 Diagnostic Applications of Pediatric Emergency POCUS 515

Pelvic and Obstetric

Ultrasound has typically been first-line in the evaluation of obstetric complaints.
POCUS for first trimester intrauterine pregnancy has been shown to decrease the
length of stay,3,43,44 have high diagnostic accuracy,45,46 and be cost effective47 in
reproductive age patients with pelvic pain and vaginal bleeding. POCUS of the
abdomen and pelvis can also assist with the rapid diagnosis of a ruptured ectopic
pregnancy and decrease the time to therapeutic intervention.48
The uterus and adnexa can be evaluated by transabdominal or transvaginal
POCUS. The transabdominal approach uses a low-frequency transducer, and a full
bladder is preferred to allow for an acoustic window and improved image resolution.
In the transvaginal approach, an empty bladder is preferred. The transvaginal
approach is typically preferred during earlier stages of the pregnancy. A beta human
chorionic gonadotropin discriminatory level of 2000 milli-international units/mL for a
transvaginal ultrasound and 6500 milli-international units/mL for transabdominal ultra-
sound has been described,49 but there is a variation in the level of beta human chori-
onic gonadotropin across pregnancies for each gestational age, and the
discriminatory levels are not always reliable; thus, clinical judgment must also be used.
When performing POCUS for an intrauterine pregnancy, the uterus should be eval-
uated in 2 planes, the transverse and longitudinal, in transabdominal and transvaginal
approaches to identify an intrauterine pregnancy. A yolk sac in the uterus is consid-
ered to be the earliest sign of confirmed intrauterine pregnancy on POCUS because
it is possible to confuse a gestational sac (part of normal early embryonic develop-
ment) with a pseudogestational sac (which can occur with an ectopic pregnancy). If
no yolk sac or fetus is visualized in the uterus, the pregnancy is considered an ectopic
until proven otherwise in a pregnant patient. Free fluid in Morison’s pouch predicts the
need for operative intervention in patients with suspected ectopic pregnancy.50 For in-
trauterine pregnancies, POCUS can also be used to determine the fetal heart rate and
estimate the gestational age (Fig. 10).

Pelvic and Gynecologic

Radiology-performed ultrasound is commonly used to evaluate nonpregnant female
patients with pelvic complaints.51 It is the first line for diagnostic imaging in pediatric
patients52 to identify pathologic processes of the uterus, adnexa, genitourinary

Fig. 8. POCUS image of gallstone with shadowing. Note the hyperechoic (white) gallstone
with shadowing. At times, the hyperechoic stone and shadowing can obscure the gall-
bladder, and only the wall is visible. This is known as the Wall Echo Shadow (WES) sign.

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516 Lin-Martore & Kornblith

Fig. 9. POCUS Image of normal gallbladder.

system, and more. However, the use of a POCUS in the evaluation of pelvic pathol-
ogies is less well understood. Although there have been case reports of POCUS being
used to identify ovarian torsion in the pediatric emergency department,53 based on
ovarian size of greater than 4 cm, asymmetry compared with the other ovary, periph-
eralization of ovarian follicles, or lack of flow in the ovaries, additional studies are
needed to understand its usefulness for this application fully. Similar to the technique
for obstetric complaints, POCUS for gynecologic complaints can be performed by
transabdominal or transvaginal approaches. However, transvaginal approaches are
avoided in patients who are younger, premenarchal, and not sexually active.

Pediatric Abdomen: Hypertrophic Pyloric Stenosis

Hypertrophic pyloric stenosis is the most common cause of intestinal obstruction in
infants presenting to the emergency department. The gold standard diagnostic study
is radiology-performed ultrasound. There have been case reports of POCUS being
used to diagnose hypertrophic pyloric stenosis54,55 successfully, and more recently,
an observational pilot study showed excellent diagnostic accuracy (sensitivity of
100% [95% CI, 62%–100%]) and specificity of 100% (95% CI, 92%–100%).56

Fig. 10. POCUS image of uterus with an intrauterine pregnancy including a fetal pole. The
crown–rump length is measured and the fetus is an estimated gestational age of 7 weeks
and 6 days.

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 Diagnostic Applications of Pediatric Emergency POCUS 517

Typically, a wide footprint, linear transducer is used with the patient a supine or de-
cubitus position. The subxiphoid area is first viewed, and the gastric wall is traced to-
ward the right until the pylorus is identified in the long axis. A muscle width of greater
than 3 mm or a channel length of greater than 17 mm is considered positive56 (Fig. 11).

Pediatric Abdomen: Intussusception

Ileocolic intussusception is the leading cause of bowel obstruction in children less
than 36 months of age.57 Radiology-performed ultrasound for intussusception has
become the diagnostic study of choice.58 Early reports suggest that POCUS for intus-
susception has comparable diagnostic accuracy to radiology-performed studies.59–61
POCUS for intussusception has also been shown to improve patient-centered met-
rics, including the decreased time to reduction and length of stay.5 More recent
studies have evaluated the best methods to teach this indication to PEM physicians.62
On ultrasound, an ileocolic intussusception typically appears as a “target” lesion in
the transverse view (Fig. 12) or a “sandwich” or “pseudo-kidney” sign in the longitu-
dinal view (Fig. 13), from the various layers of bowel telescoped within each other
(intussusceptum and intussuscipiens). The entire large bowel from the right lower
quadrant to the right upper quadrant to the left upper quadrant and finally to the left
lower quadrant is scanned using a wide footprint, high-frequency, linear probe. Typi-
cally, ileocolic intussusception will appear on the right side of the abdomen and have a
diameter of 2 cm or greater in the transverse view. Small bowel–small bowel

Fig. 11. POCUS image of hypertrophic pyloric stenosis with muscle width measured at
greater than 3 mm.

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518 Lin-Martore & Kornblith

Fig. 12. POCUS of a “target sign” lesion measuring 2.63 cm. This is an intussusception in the
transverse view. Not the hyperechoic (white) center of mesenteric fat with a hypoechoic
(dark) lymph node in the center.

intussusceptions can also appear as target or pseudo-kidney lesions, but tend to be

smaller (<2 cm) and may not be located in the right side of the abdomen63,64; these
often can resolve without procedural intervention.

Pediatric Abdomen: Appendicitis

Appendicitis is one of the most common pediatric surgical emergencies.65 Diagnosti-
cally, ultrasound is preferred in children over a CT scan owing to the lack of ionizing
radiation, and it is often preferred over MRI owing to availability.66–68 A recent system-
atic review and meta-analysis of POCUS for appendicitis by emergency providers in
pediatric patients showed a sensitivity of 89% (95% CI, 47%–99%) and a specificity
of 97% (95% CI, 84%–99%).69 POCUS can potentially decrease CT scan use and
decrease emergency department lengths of stay for children with suspected
appendicitis.4,70
The 3 general approaches for POCUS for appendicitis include: scanning the point of
maximal pain, scanning in a protocolized manner in the right lower quadrant,71 and
following the psoas muscle and iliac vessels in the right lower quadrant. In this last
method, the probe can be placed inferiorly in the right lower quadrant with initially
only muscle and no bowel visualized, as the probe is moved cephalad, the first loop
of bowel visualized is typically the cecum. The appendix can be identified as a tubular,
aperistaltic, blind ending structure deriving from the cecum. Appendicitis is described
as a noncompressible appendix that is greater than 6 mm in diameter (Figs. 14 and
15),72,73 It often can be accompanied by secondary findings of inflammation, including
visualization of an appendicolith, free fluid, or hyperechoic fat stranding.74 Oftentimes
an appendix cannot be visualized on ultrasound, especially in patients with a higher
body mass index.75 For POCUS for appendicitis, nonvisualized appendix studies
continue to represent a diagnostic dilemma,69,71 although in the proper clinical sce-
nario with no secondary signs of inflammation on ultrasound, it can decrease the
concern for appendicitis.76,77

Lung
Lung POCUS has been described as a promising tool in the diagnosis of pediatric
pneumonia and other lung pathology.78 In one recent systematic review and meta-
analysis for diagnostic accuracy for pneumonia in children, POCUS had high sensi-
tivity and specificity 0.94 (interquartile range, 0.89–0.97), 0.93 (interquartile range,
0.86–0.98), although the authors note limitations in reference standard and variability

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 Diagnostic Applications of Pediatric Emergency POCUS 519

Fig. 13. POCUS of a “sandwich” or “pseudokidney” sign. This is the intussusception viewed
longitudinally with alternating layers of the intussuscipiens and intussusceptum. This had
been noted to look like a kidney given the hyperechoic (bright) center.

of practitioner experience. Still, some proponents of POCUS have stated it may be

feasible to substitute lung POCUS for chest radiography in the diagnosis of pediatric
pneumonia.79 Studies have also described using lung POCUS to distinguish viral from
bacterial pneumonia during the H1N1 pandemic,80 and lung POCUS incorporation
into clinical decision-making has been described during the COVID-19 pandemic.81
A high-frequency, linear probe or a low-frequency, curvilinear probe can be used to
evaluate the lungs depending on patient size and habitus. The lungs are typically
viewed with the probe orthogonal to ribs and the anterior, lateral, and posterior chest
are evaluated. Findings concerning for pneumonia can include consolidations (where
lung tissue seems to be almost like a solid organ), bronchograms (air trapped within
the airways), and focal B-lines (Fig. 16). Pleural effusions can be seen with pneumonia,
but can also be seen with other pathologies.

Ocular
The role of POCUS in evaluation of pediatric patients with ocular complaints is still un-
der investigation. Optic nerve swelling can be used to help identify children with
increased intracranial pressure and there have been pediatric studies of emergency
medicine physician-performed POCUS evaluating for optic nerve swelling that have

Fig. 14. POCUS of appendicitis, transverse view, with tubular structure measuring 0.84 cm.

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520 Lin-Martore & Kornblith

Fig. 15. POCUS of appendicitis, longitudinal view, with blind ending tube measuring
0.88 cm.

shown good sensitivity (90%–96%) but poor specificity (48%–55%).82,83 Ocular

POCUS has also been used to assess children with diabetic ketoacidosis for
increased intracranial pressure,84 although their accuracy remains unclear.85 Addi-
tionally, an ocular POCUS study of patients with suspected ventriculoperitoneal shunt
failure found a sensitivity of 61.1% and specificity of 22.0% for shunt malfunction.86
There have been case reports of the use of POCUS in the diagnosis of various intra-
ocular complaints such as cataracts, Coats disease, and vitreous hemorrhage, as well
as retro-orbital issues and other diagnoses such as optic neuritis.87,88 Its use has also
been described in facilitating evaluation of patients with difficult eye examinations.89
Further studies are needed to understand the accuracy of POCUS for these
diagnoses.
A high-frequency, linear probe is used to perform ocular POCUS. If the child cannot
voluntarily close their eyes, a clear adhesive film strip can be applied or gel can be
applied directly to the closed eyelid. The globe is evaluated in a horizontal axial, ver-
tical axial, and vertical transverse orientations. The optic nerve can be evaluated using

Fig. 16. POCUS image of a pulmonary consolidation with pleural effusion.

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 Diagnostic Applications of Pediatric Emergency POCUS 521

Fig. 17. Ocular POCUS with measurement of optic nerve sheath diameter 3 mm behind
retina.

the optic nerve sheath diameter (measured 3 mm behind the retina) (Fig. 17), with
4.5 mm being the cutoff for normal in children 1 year old and older and 4.0 mm being
the cutoff for children less than 1 year,83,90,91 and 5 mm being the cutoff in adults
(sonoguide.com). Optic disc elevation (>1 mm) and the crescent sign (fluid around
the optic nerve) can also be evaluated with a POCUS.91
Testicular
The evaluation of acute testicular pain is time sensitive and its diagnostic differential in-
cludes emergency diagnoses such as testicular torsion and incarcerated/strangulated
hernia. The literature in adult and pediatric patients for testicular POCUS is limited and,
therefore, these examinations are not considered a core study application, although there
are retrospective data that show that POCUS for pediatric testicular torsion can be accu-
rate.92 Furthermore, these studies require a level of expertise in flow imaging modes. A
high-frequency transducer with color and spectral Doppler can be used to evaluate
and compare blood flow to each testis. However, the physiologic low blood flow velocity
of the prepubertal testis may make this study uniquely challenging. A hernia appears as
fluid-filled bowel within the inguinal canal or scrotum.

SUMMARY

Diagnostic applications of PEM POCUS, including FAST, extended FAST, cardiac,

IVC, bladder, renal, gallbladder/biliary, pelvis–obstetrics and gynecology, pediatric
abdomen–intussusception, appendicitis, and pyloric stenosis, pulmonary, ocular
and testicular complaints, their evidence and techniques are summarized elsewhere
in this article. Integrating POCUS into clinical care can aid in expediting diagnosis
and improving care for children in the emergency department. Understanding the ev-
idence behind POCUS applications as well as their techniques is key to using these
POCUS applications in PEM practice.

CLINICS CARE POINTS

 POCUS has a variety of diagnostic applications in PEM and has become an essential part of
PEM practice.
 Promising diagnostic POCUS applications according to expert consensus are FAST, E-FAST,
cardiac, IVC, bladder, renal, gallbladder/biliary, pelvis–obstetrics and gynecology, pediatric
abdomen–intussusception, appendicitis, and pyloric stenosis, pulmonary, ocular and
testicular complaints.

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522 Lin-Martore & Kornblith

 Evidence for each POCUS application varies and many applications lack randomized,
controlled trials.
 Understanding the evidence for each POCUS application can assist providers in deciding
how to best use POCUS in clinical care.
 Benefits of POCUS include decreased patient lengths of stay for a variety of pediatric
diagnostic applications, as well as lack of ionizing radiation and improved patient
satisfaction.

DISCLOSURE

The authors have no conflicts to disclose.

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