Impact of point-of-care ultrasound (POCUS) in pediatric emergency departments: a meta-analysis of randomized controlled trials

Point-of-care ultrasound (POCUS) is a bedside diagnostic tool clinicians use to provide immediate insights and guide therapeutic interventions. It has become increasingly significant in pediatric emergency departments (EDs) for diagnosing conditions, managing critical scenarios, and guiding procedures due to its portability, ease of use, and lack of radiation. This study aims to systematically review and analyze the efficacy of POCUS compared to conventional diagnostic methods in pediatric emergency settings. A literature search was conducted across PubMed, SCOPUS, Web of Science, Embase, and Cochrane Library up to February 2025. The inclusion criteria were pediatric patients aged 1 month to 18 years in EDs, with studies comparing POCUS to conventional methods. Primary outcomes included first-attempt procedural success and overall success rates. Secondary outcomes included time to procedure completion, mean number of attempts, hospitalization rates, and discharge rates. Data analysis was conducted in R employing a random-effects model, with dichotomous data analyzed as risk ratio (RR) and 95% confidence interval (CI), and continuous data as unbiased standardized mean difference (SMD). Statistical significance was defined at p < 0.05. Eighteen randomized controlled trials involving 2264 patients met the inclusion criteria. POCUS significantly improved first-attempt success (RR = 1.25; 95% CI: 1.09-1.43). The overall procedural success showed a significant benefit with POCUS (RR = 1.12; 95% CI: 1.03-1.22). However, no significant differences were noted in the time to procedure completion, number of attempts for a successful procedure, and rates of hospitalization and discharge to home. POCUS significantly improves first-attempt and overall procedural success rates in pediatric emergency settings, although it does not significantly reduce procedure times or the number of attempts. These findings underscore the importance of integrating POCUS into pediatric emergency care to enhance diagnostic accuracy and procedural success, though further research is needed to optimize its implementation across different age groups and procedures.