{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T19:34:54Z","timestamp":1764617694914,"version":"3.46.0"},"reference-count":15,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"12","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2025,12]]},"abstract":"<jats:sec>\n                    <jats:title>Objectives:<\/jats:title>\n                    <jats:p>Point-of-care ultrasonography (POCUS) for skin and soft tissue infections (SSTIs) has been integrated into routine clinical care in pediatric emergency medicine (PEM). Despite its widespread utilization, empirical data on skill development are required to inform standards of care. We sought to evaluate the accuracy of POCUS for the detection of SSTIs, and to estimate a learning curve as providers gained experience.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>A database was created at a single urban pediatric emergency department (ED) for all POCUS studies performed for cellulitis and abscess among children from August 2009 to January 2020. Providers who completed at least 10 total studies were included. The accuracy of each study was asynchronously rated by 6 POCUS experts. We report each provider\u2019s learning curve. Within the provider, the studies were ordered temporally. Mixed-effect logistic regression was used to model study accuracy with study accuracy as the dependent variable, within-provider examination temporal order as a fixed effect, and random effects for provider-level intercept and longitudinal slope.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>\n                      A total of 3408 ultrasounds by 87 providers were included. The median number of ultrasounds per provider was 32 (range: 10 to 184). Accuracy increased significantly with each additional scan [odds ratio: 1.02 (1.01, 1.03)]. Significant variability was found across provider-level intercepts (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      &lt; 0.001) but not across slopes (\n                      <jats:italic toggle=\"yes\">P<\/jats:italic>\n                      = 0.215). To reach mean accuracy levels of 90% and 95%, averages of 29 and 80 scans were required, respectively.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>POCUS accuracy for detecting pediatric SSTIs improved with experience, with a mean of 29 scans required to reach 90% accuracy.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/pec.0000000000003467","type":"journal-article","created":{"date-parts":[[2025,8,8]],"date-time":"2025-08-08T05:00:19Z","timestamp":1754629219000},"page":"e205-e209","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Learning Curve for Point-of-Care Ultrasonography for Pediatric Skin and Soft Tissue Infections"],"prefix":"10.1097","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7655-3483","authenticated-orcid":false,"given":"Jeffrey T.","family":"Neal","sequence":"first","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Andrew F.","family":"Miller","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cynthia A.","family":"Gravel","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jason A.","family":"Levy","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mark I.","family":"Neuman","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Michael C.","family":"Monuteaux","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rachel G.","family":"Rempell","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Children\u2019s Hospital of Philadelphia, Philadelphia, PA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Martin V.","family":"Pusic","sequence":"additional","affiliation":[{"name":"Department of Pediatrics, Division of Emergency Medicine, Boston Children\u2019s Hospital, Boston, MA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"276","published-online":{"date-parts":[[2025,8,8]]},"reference":[{"key":"R1-20251201","doi-asserted-by":"crossref","first-page":"e1113","DOI":"10.1542\/peds.2015-0343","article-title":"Point-of-care ultrasonography by pediatric emergency medicine physicians","volume":"135","author":"Marin","year":"2015","journal-title":"Pediatrics"},{"key":"R2-20251201","doi-asserted-by":"crossref","first-page":"e1687","DOI":"10.1097\/PEC.0000000000001677","article-title":"Credentialing pediatric emergency medicine faculty in point-of-care ultrasound: expert guidelines","volume":"37","author":"Abo","year":"2019","journal-title":"Pediatr Emerg Care"},{"key":"R3-20251201","doi-asserted-by":"crossref","first-page":"e186","DOI":"10.1097\/PEC.0000000000003193","article-title":"Characterizing point-of-care ultrasound credentialing in pediatric emergency departments","volume":"40","author":"Brant","year":"2024","journal-title":"Pediatr Emerg Care"},{"key":"R4-20251201","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1016\/S0196-0644(01)70030-3","article-title":"American College of Emergency Physicians. ACEP emergency ultrasound guidelines-2001","volume":"38","year":"2001","journal-title":"Ann Emerg Med"},{"key":"R5-20251201","doi-asserted-by":"crossref","first-page":"550","DOI":"10.1016\/j.annemergmed.2008.12.013","article-title":"Emergency ultrasound guidelines","volume":"53","year":"2009","journal-title":"Ann Emerg Med"},{"key":"R6-20251201","doi-asserted-by":"crossref","first-page":"e27","DOI":"10.1016\/j.annemergmed.2016.08.457","article-title":"Ultrasound guidelines: emergency, point-of-care and clinical ultrasound guidelines in medicine","volume":"69","year":"2017","journal-title":"Ann Emerg Med"},{"key":"R7-20251201","doi-asserted-by":"crossref","first-page":"e115","DOI":"10.1016\/j.annemergmed.2023.06.005","article-title":"Ultrasound guidelines: emergency, point-of-care, and clinical ultrasound guidelines in medicine","volume":"82","year":"2023","journal-title":"Ann Emerg Med"},{"key":"R8-20251201","doi-asserted-by":"crossref","first-page":"472","DOI":"10.1016\/j.annemergmed.2015.01.028","article-title":"Point-of-care ultrasonography by pediatric emergency physicians. Policy statement","volume":"65","author":"Marin","year":"2015","journal-title":"Ann Emerg Med"},{"key":"R9-20251201","doi-asserted-by":"crossref","first-page":"574","DOI":"10.1111\/acem.12653","article-title":"Learning curves in emergency ultrasound education","volume":"22","author":"Blehar","year":"2015","journal-title":"Acad Emerg Med"},{"key":"R10-20251201","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1111\/j.1553-2712.2010.00990.x","article-title":"Assessment of a training curriculum for emergency ultrasound for pediatric soft tissue infections","volume":"18","author":"Marin","year":"2011","journal-title":"Acad Emerg Med"},{"key":"R11-20251201","doi-asserted-by":"crossref","first-page":"e849","DOI":"10.1097\/PEC.0000000000002396","article-title":"Learning pediatric point-of-care ultrasound: how many cases does mastery of image interpretation take?","volume":"38","author":"Kwan","year":"2022","journal-title":"Pediatr Emerg Care"},{"key":"R12-20251201","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.annemergmed.2022.11.002","article-title":"Competency standard derivation for point-of-care ultrasound image interpretation for emergency physicians","volume":"81","author":"Harel-Sterling","year":"2023","journal-title":"Ann Emerg Med"},{"key":"R13-20251201","doi-asserted-by":"crossref","first-page":"31","DOI":"10.1186\/s13089-023-00329-2","article-title":"Learning curves for point-of-care ultrasound image acquisition for novice learners in a longitudinal curriculum","volume":"15","author":"Breunig","year":"2023","journal-title":"Ultrasound J"},{"key":"R14-20251201","doi-asserted-by":"crossref","first-page":"1476","DOI":"10.1111\/acem.12043","article-title":"Experience curves as an organizing framework for deliberate practice in emergency medicine learning","volume":"19","author":"Pusic","year":"2012","journal-title":"Acad Emerg Med"},{"key":"R15-20251201","doi-asserted-by":"crossref","first-page":"756","DOI":"10.1080\/0142159X.2019.1570098","article-title":"The effect of testing and feedback on the forgetting curves for radiograph interpretation skills","volume":"41","author":"Boutis","year":"2019","journal-title":"Med Teach"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003467","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,12,1]],"date-time":"2025-12-01T19:00:37Z","timestamp":1764615637000},"score":1,"resource":{"primary":{"URL":"https:\/\/journals.lww.com\/10.1097\/PEC.0000000000003467"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,8,8]]},"references-count":15,"journal-issue":{"issue":"12","published-print":{"date-parts":[[2025]]}},"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000003467","relation":{},"ISSN":["0749-5161","1535-1815"],"issn-type":[{"type":"print","value":"0749-5161"},{"type":"electronic","value":"1535-1815"}],"subject":[],"published":{"date-parts":[[2025,8,8]]},"assertion":[{"value":"2025-02-12","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2025-07-20","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}