P2 (PEM POCUS) Network

Sam Lam, MD, MPH, FACEP

Pediatric emergency medicine (PEM) is a young subspecialty that is growing and changing quickly. Progress in PEM has generally followed developments in general emergency medicine, while also advancing the level of pediatric emergency care. Point-of-care ultrasound (POCUS) tends to follow such a trajectory. Over the last two decades, the use of POCUS in PEM has grown exponentially. The American Board of Pediatrics now includes POCUS in the core content guidelines for PEM fellow education.¹

In May 2014, a group of 46 pediatric POCUS leaders from North America met in Toronto, Canada, for a 2-day conference. The group aimed to further collaboration in PEM POCUS research, educational, administrative, and mentorship endeavors. Topics discussed included the barriers, challenges, and future goals for PEM POCUS. At the conclusion of this meeting, the P2Network was born. The “P2” in the group name stands for “PEM POCUS.”

The P2Network is a multinational organization, with over 230 members from North America, South America, Europe and Asia. It is governed by an executive committee of elected officers. The P2Network's vision is to be the premier international platform for collaboration in PEM POCUS. Its missions are (1) to promote the evidence-based application of pediatric POCUS to facilitate care in the clinical setting, (2) to build collaborative relationships and share expertise between individuals within the P2Network, (3) to work with educators and researchers within and outside the field to include different perspectives on issues related to PEM POCUS and influence practice, and (4) to offer mentorship to our members. Since its formation, the P2Network has strategically paired its annual conferences with the Pediatric Academic Societies (PAS) Meeting or the SAEM Annual Meeting, which has allowed members to be concurrently exposed to research presentations and didactics in their areas of interest.

Research in PEM POCUS faces many unique challenges. Many of the early pioneers tend to be the sole expert in their own departments or divisions. They are expected to take on educational, administrative, as well as research responsibilities in this new niche of academic medicine, in addition to their clinical obligations. This places a constraint on their time and may discourage sustained efforts in producing quality research. Additionally, PEM POCUS research mentorship is difficult to find due to a lack of well-established researchers in the area. On a global scale, incidence of pathology tends to be lower in the pediatrics emergency department (PED) setting compared to their adult counterparts. Many PEDs also see a much lower patient volume. To tackle these problems, the P2Network has sponsored several multi-institutional clinical studies to help aggregate adequate sample sizes to generate enough power, and to enroll across diverse sites for generalizability of outcomes. Examples of these include the soft tissue infection study,² the intussusception study,³ and the ongoing PLEXUS (femoral nerve block) study. Recently, the P2Network has also published a Delphi study on PEM POCUS research priorities to serve as a roadmap for aspiring researchers.⁴ In terms of educational research, the P2Network has utilized its expertise to create consensus guidelines in PEM POCUS education for PEM and PEM POCUS fellows.^5,6 It has also published a curriculum and POCUS competency checklist for PEM fellows.⁷

Moving forward on its 10^th anniversary, the P2Network is always open to partnering with other professional organizations such as the ACEP Ultrasound Section on topics of mutual interest. Please do not hesitate to reach out for any ideas or questions.

References

1. American Board of Pediatrics. Content Outline: Pediatric Emergency Medicine. Available at: https://www.abp.org/sites/abp/files/pdf/content-outline-emergency-medicine.pdf. Accessed January 15, 2014.
2. Lam SHF, Sivitz A, Alade K, et al. Comparison of Ultrasound Guidance vs. Clinical Assessment Alone for Management of Pediatric Skin and Soft Tissue Infections. J Emerg Med. 2018;55(5):693-701.
3. Bergmann KR, Arroyo AC, Tessaro MO, et al. Diagnostic Accuracy of Point-of-Care Ultrasound for Intussusception: A Multicenter, Noninferiority Study of Paired Diagnostic Tests. Ann Emerg Med. 2021;78(5):606-15.
4. Snelling PJ, Shefrin AE, Moake MM, et al. Establishing the international research priorities for pediatric emergency medicine point-of-care ultrasound: A modified Delphi study. Acad Emerg Med. 2022;29(11):1338-46.
5. Shefrin AE, Warkentine F, Constantine E, et al. Consensus Core Point-of-care Ultrasound Applications for Pediatric Emergency Medicine Training. AEM Educ Train. 2019;3(3):251-58.
6. Constantine E, Levine M, Abo A, et al. Core Content for Pediatric Emergency Medicine Ultrasound Fellowship Training: A Modified Delphi Consensus Study. AEM Educ Train. 2019;4(2):130-8.
7. Gold D, Levine M, Hsu D, et al. Design of a point-of-care ultrasound curriculum for pediatric emergency medicine fellows: A Delphi study. AEM Educ Train. 2021;5(4):e10700.