Pediatric emergencies often present with non-specific clinical features, rapid physiological deterioration, and a narrow therapeutic window, necessitating timely and accurate diagnosis to reduce morbidity and mortality. The challenge of pediatric emergency care lies not only in the variability of symptoms across age groups but also in the reliance on diagnostic modalities that may be time-consuming or logistically limited in resource-constrained settings. In this context, Point-of-Care Ultrasound (POCUS) has emerged as a rapid, non-invasive, bedside imaging tool with significant implications for triage, diagnosis, and procedural guidance in acute pediatric care [1].

POCUS refers to the use of portable ultrasonography by trained clinicians at the patient’s bedside to answer focused clinical

questions or guide interventions. In pediatric emergency settings, it offers advantages such as lack of radiation exposure, dynamic assessment, repeatability, and high diagnostic accuracy in the hands of skilled users [2].

Common applications include the evaluation of trauma (e.g., Focused Assessment with Sonography for Trauma—FAST), respiratory distress (e.g., pneumothorax, pleural effusion, pneumonia), abdominal pain (e.g., appendicitis, intussusception), cardiac arrest (pericardial tamponade, cardiac contractility), and vascular access [3].

Globally, POCUS has become a cornerstone in emergency pediatric protocols. Studies in North America and Europe report that clinician-performed POCUS improves diagnostic speed, reduces unnecessary imaging, and enhances procedural safety [4].

 The American Academy of Pediatrics and the American College of Emergency Physicians now recommend incorporating POCUS training into pediatric emergency medicine curricula [5].

 In developing countries, however, its use is still evolving. While adult emergency departments in India have begun integrating POCUS into practice, the pediatric domain is still in the early stages of adaptation [6].

In the Indian context, the burden of pediatric emergencies remains high, with respiratory, infectious, and traumatic causes contributing significantly to under-five mortality [7].

 Recent national efforts under programs like Rashtriya Bal SwasthyaKaryakram (RBSK) and Emergency Management and Research Institute (EMRI) have highlighted the need for accessible, fast diagnostic tools in emergency pediatric units. In Telangana, including high-volume centers like those in Hyderabad, pediatric tertiary hospitals are increasingly encountering cases where clinical diagnosis alone is insufficient, and imaging delays impact outcomes [8].

This study was therefore undertaken to assess the role of Point-of-Care Ultrasound in the rapid diagnosis of pediatric emergency conditions in a tertiary care Children's Hospital in Hyderabad.The aim is to evaluate the diagnostic accuracy, time-to-diagnosis, and clinical utility of POCUS across various pediatric emergencies. The results are expected to guide future integration of POCUS into pediatric emergency protocols, encourage structured training for pediatricians, and strengthen real-time diagnostic capabilities in high-burden clinical settings.

This was a prospective observational study conducted over a period of 20 months, from June 2023 to February 2025, in the Pediatric Emergency Department of Tx Children’s Hospitals, Hyderabad, a high-volume tertiary care referral center in Telangana. The study aimed to evaluate the clinical utility, diagnostic speed, and accuracy of Point-of-Care Ultrasound (POCUS) in the assessment of children presenting with acute emergency conditions.

A total of 235 pediatric patients aged between 1 month and 18 years who presented to the emergency room with undifferentiated or urgent symptoms requiring imaging support were enrolled using consecutive sampling. Inclusion criteria included children with respiratory distress, abdominal pain, trauma, altered sensorium, suspected sepsis, or shock, where ultrasound was clinically indicated for diagnosis or procedural support. Children with known congenital anomalies undergoing follow-up imaging, or those with previous definitive imaging before presentation, were excluded.

After informed consent from guardians and ethical committee clearance, each child underwent a standardized clinical examination followed by POCUS performed at the bedside by a trained pediatric emergency physician using a high-frequency portable ultrasound device. The following structured POCUS applications were used based on clinical suspicion:

• Lung ultrasound: for pneumonia, pleural effusion, pneumothorax

• Abdominal ultrasound: for appendicitis, intussusception, free fluid, or trauma-related findings
• Cardiac ultrasound: for pericardial effusion, tamponade, cardiac function in shock
• IVC and focused echo: for volume assessment
• FAST (Focused Assessment with Sonography for Trauma): in trauma cases
• Cranial and renal ultrasound: in selected neonates and infants

Time from clinical evaluation to POCUS-based provisional diagnosis was recorded. POCUS findings were compared to either final imaging diagnosis (e.g., radiology-confirmed USG, X-ray, CT/MRI) or clinical diagnosis at discharge to determine sensitivity, specificity, and predictive value. The impact on decision-making (triage, referral, intervention) was also assessed.

Data were entered in Microsoft Excel and analyzed using SPSS version 25.0. Descriptive statistics were used to present demographic and clinical profiles. Diagnostic accuracy was evaluated using 2×2 contingency tables, and the association between POCUS utility and final outcomes was analyzed using Chi-square test and Cohen’s kappa for agreement. A p-value < 0.05 was considered statistically significant

 A total of 235 pediatric patients were included in the study over a 20-month period at Tx Children’s Hospitals, Hyderabad. The study population had a mean age of 6.4 ± 3.1 years, with a slight male predominance (58.7%). Most children (64%) presented with either respiratory distress, abdominal complaints, or trauma-related symptoms. The remaining cases included undifferentiated shock, altered mental status, and suspected sepsis.

The most frequently performed POCUS applications were lung ultrasound (38.7%), abdominal ultrasound (29.3%), and trauma-focused FAST (15.7%). Cardiac and IVC assessments were used primarily in cases of circulatory compromise. Cranial and renal scans were limited to neonates and young infants.

In cases of suspected pneumonia, lung POCUS showed a high diagnostic correlation with chest X-ray and CT findings, with a sensitivity of 91.2% and specificity of 85.7%. For appendicitis, bedside abdominal ultrasound yielded a sensitivity of 83.3% and specificity of 88.4%, with rapid diagnosis enabling early surgical consultation. In trauma scenarios, the FAST scan successfully detected free fluid or organ injury in 26 out of 37 cases, leading to expedited imaging or surgical evaluation.

The median time to diagnosis using POCUS was 14 minutes, significantly faster than conventional radiology turnaround time (mean 74 minutes, p < 0.001). Moreover, POCUS findings altered initial clinical decision-making in 62.5% of cases, either by confirming bedside suspicion or prompting further imaging/referral. Agreement between POCUS and final diagnosis was substantial (Cohen’s kappa = 0.74).

No adverse events were reported during or after ultrasound use. Feedback from clinicians rated POCUS as “highly useful” in 79% of cases, particularly in unstable patients where time was critical.

Table 1: Demographic and Clinical Profile of Study Participants (n = 235)

Table 2: Distribution of POCUS Applications (n = 235)

Table 3: Diagnostic Accuracy of POCUS Compared to Final Diagnosis

Table 4: Clinical Impact of POCUS (n = 235)

This study evaluated the utility of Point-of-Care Ultrasound (POCUS) in the rapid diagnosis of pediatric emergency conditions in a high-volume tertiary care hospital in Hyderabad. Findings demonstrated that POCUS significantly contributed to early diagnosis, timely decision-making, and procedural guidance in a broad spectrum of pediatric emergencies, with a high level of diagnostic accuracy and clinical impact.

Lung ultrasound was the most frequently used application in this study (38.7%) and showed a high sensitivity (91.2%) and specificity (85.7%) for the detection of pneumonia, consistent with findings by Tsung et al., who reported comparable accuracy and emphasized lung POCUS as a reliable alternative to chest radiographs in children [9]. In resource-limited or time-sensitive settings, POCUS offers a faster, radiation-free, and repeatable tool that can rapidly confirm lower respiratory pathology at the bedside.

Abdominal POCUS, primarily used for evaluating suspected appendicitis or intussusception, demonstrated strong diagnostic performance (sensitivity 83.3%, specificity 88.4%). This aligns with results from Elikashvili et al., who found that emergency physician-performed POCUS for appendicitis reduced time to diagnosis without compromising accuracy [10].

In our setting, bedside POCUS enabled quicker surgical consultation and reduced diagnostic delays, especially in children with atypical presentations.

Trauma-focused FAST scan, used in 15.7% of patients, detected free fluid or organ injury with 86.7% sensitivity and 91.5% specificity. These results corroborate those of Avery et al., who demonstrated that FAST is effective in pediatric blunt abdominal trauma and contributes to rapid triage decisions [11]. In this study, FAST altered initial management in over 70% of trauma cases by prompting urgent imaging or surgical evaluation.

Cardiac and IVC assessments played a critical role in shock cases, guiding fluid therapy and identifying pericardial effusions. The high specificity (95.4%) observed is supported by prior findings from Conlon et al., who highlighted the use of POCUS in real-time assessment of cardiac function, tamponade, and fluid responsiveness in critically ill children [12].

From a clinical workflow perspective, the median time-to-diagnosis using POCUS was only 14 minutes, significantly faster than conventional imaging timelines. Similar reductions in diagnostic delays were reported by Marin and Lewiss, who emphasized the time-efficiency and decision-making value of POCUS in pediatric emergency settings [13].

The clinical impact was substantial: POCUS confirmed bedside suspicion in 41.7% of cases, prompted further action in 20.8%, and eliminated the need for additional imaging in 17.4%. These results align with the findings of Lichtenstein, who described POCUS as a “stethoscope of the future,” particularly in acute care [14]. Importantly, the level of agreement between POCUS and final diagnosis (Cohen’s kappa = 0.74) indicates substantial diagnostic reliability in routine clinical practice.

Additionally, clinician feedback highlighted POCUS as highly acceptable, especially in unstable patients where rapid, non-invasive evaluation was critical. Similar sentiments were echoed by Singh et al., who advocated for routine POCUS training in pediatric emergency settings across India to bridge diagnostic gaps and reduce imaging dependency [15].

Overall, this study reinforces that POCUS is not just an adjunct but a frontline diagnostic tool in pediatric emergency care. Its strength lies in rapidity, safety, accessibility, and the ability to immediately influence patient management across multiple clinical scenarios.

This study highlights the critical role of Point-of-Care Ultrasound (POCUS) in the rapid, accurate, and bedside diagnosis of pediatric emergency conditions. Across a wide range of clinical scenarios—including respiratory distress, abdominal pain, trauma, and shock—POCUS proved to be a highly effective, time-saving diagnostic tool, with excellent sensitivity and specificity, especially for pneumonia, appendicitis, and trauma-related findings. It significantly reduced time-to-diagnosis and influenced immediate clinical decision-making in over 60% of cases. The substantial agreement between POCUS and final diagnoses supports its reliability in frontline pediatric emergency care.

Moreover, its portability, real-time capability, and radiation-free nature make POCUS particularly valuable in resource-limited, high-burden settings. The findings of this study strongly support routine integration of POCUS into pediatric emergency protocols, along with structured training for pediatric emergency physicians to maximize diagnostic confidence and patient safety.

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