Recommendations on actions to avoid when performing point-of-care ultrasound in pediatric emergency departments - 14/02/26

Doi : 10.1016/j.arcped.2026.105480

Roser Martínez-Mas ^a,^b, Adrián Ranera Málaga ^c,^d, Fidel Gallinas-Victoriano ^e,^f, Frederic Samson ^g,^h, Isabel González-Bertolín ^i,^j, Patricia Bote Gascón ^i,^j, Parisá Khodayar-Pardo ^k,^l,^⁎

^a Pediatric Emergency Department, Cruces University Hospital, BioCruces Bizkaia Health Research Institute, Barakaldo, Spain

^b Coordinator of the Working Group on Clinical Ultrasound of the Spanish Society of Pediatric Emergency Medicine. Cruces Plaza, s/n, 48903 Barakaldo, Bizkaia, Spain

^c Pediatric Emergency Department, Corporació Sanitaria Parc Taulí, Institut d’Investigació e innovació. I3PT Sabadell, Spain

^d Member of the Working Group on Clinical Ultrasound of the Spanish Society of Pediatric Emergency Medicine. Parc Taulí, 1, 08208 Sabadell, Barcelona, Spain

^e Division of Pediatric Emergency Medicine, Department of Pediatrics, University Hospital of Navarra, Pamplona, Spain

^f Member of the Working Group on Clinical Ultrasound of the Spanish Society of Pediatric Emergency Medicine. Irunlarrea, 3, 31004 Pamplona, Spain

^g Division of Pediatric Emergency Medicine, Basurto University Hospital, Bilbao, Spain

^h Av. Montevideo, 18, Basurto, 46013 Bilbao, Bizkaia, Spain

ⁱ Pediatric Emergency Department, La Paz University Hospital, Madrid, Spain

^j Member of the Working Group on Clinical Ultrasound of the Spanish Society of Pediatric Emergency Medicine. P° de la Castellana, 261, Fuencarral-El Pardo, 28046 Madrid, Spain

^k Department of Pediatrics. Consorcio Hospital General Universitario de Valencia. Spain

^l Member of the Working Group on Clinical Ultrasound of the Spanish Society of Pediatric Emergency Medicine. Av . Tres Cruces, 2. 46014 Valencia, Spain

^⁎ Corresponding author at: Consorcio Hospital General Universitario de Valencia, Av. Tres Cruces, 2, 46014, València, Spain. Consorcio Hospital General Universitario de Valencia Av. Tres Cruces València 246014 Spain

En prensa. Pruebas corregidas por el autor. Disponible en línea desde el Saturday 14 February 2026

Highlights

•	The actions to avoid when using Point-of-care ultrasound (POCUS) might increase its safe and effective use in Pediatric Emergency Department (PED).
•	Adequate POCUS training ensures a systematic approach and correct interpretation of results.
•	It is important to consider the clinical context, e.g. when identifying ‘lung consolidations’.
•	A negative focused assessment with sonography for trauma (FAST) examination is unable to rule out abdominal injury.
•	POCUS should not delay resuscitation of a patient with cardiac arrest or a computed tomography (CT) scan in traumatic brain injury (TBI).

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Abstract

Background

Contrary to the classic method of learning from experts and gradually assuming responsibility, a new trend that identifies the most common mistakes and common misconceptions is proving to be very beneficial in learning medical procedures such as Point-of-care ultrasound (POCUS) for both less experienced and more experienced professionals.

Objective

To present the elaboration process and results of the list of actions to avoid in Point-of-Care Ultrasound (POCUS) use in the pediatric emergency department (PED) within the Working Group on Clinical Ultrasound of the Spanish Society of Pediatric Emergency Medicine (GTEC-SEUP).

Methods and settings

The process was carried out in 3 phases: (1) ”Brainstorming”, open to all GTEC-SEUP members; (2) Selection of recommendations, following a modified Delphi methodology. Participants were asked to rank the recommendations (from 1=”total disagreement” to 9=”total agreement”). Recommendations with an average score ≥8 (and ranked a minimum of 7 by at least 2/3 of participants) were accepted, and those with an average score <6 were rejected. Doubtful recommendations (not meeting accepted or rejected criteria) were submitted to a second round of evaluation; (3) Drafting and consensus of the final document.

Results

40 proposals for “actions to avoid” were retrieved, which were reduced to 33 after unifying and eliminating similar proposals. After the first round, 8 recommendations were accepted and 2 rejected. After the second round of evaluation, one more recommendation was accepted. The final document includes 9 recommendations: 4 referring to general principles of POCUS and 5 to specific POCUS applications: lung, Focused Assessment with Sonography for Trauma, focused cardiac, cardiac arrest, and skull POCUS.

Conclusions

The list of ”actions to avoid” in POCUS use in the PED is a consensual tool within the GTEC-SEUP. These recommendations advocate for a standardized and rational utilization of POCUS, promoting an improvement in safety and efficacy in the PED.

El texto completo de este artículo está disponible en PDF.