Diagnostic accuracy of point-of-care ultrasound for confirming endotracheal tube placement in pediatric acute care settings: a systematic review and meta-analysis.

objectiveTo evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) for confirming endotracheal tube (ETT) placement in pediatric patients within emergency and critical care settings, compared with standard methods such as chest radiography and capnography.

methodsA systematic search of PubMed, Embase, Scopus, Web of Science, and the Cochrane Library was conducted from inception to May 2025. Prospective studies assessing POCUS for confirmation of endotracheal placement in pediatric patients (birth to 18 years) within acute care settings (including emergency departments, intensive care units, and operating rooms) were included. Data on diagnostic accuracy (Sensitivity, Specificity, Summary receiver operating characteristic (SROC) curve, and Diagnostic odds ratio (DOR)), POCUS success rate, Confirmation of ETT placement, Time to adequate view, Reintubation rate, as well as baseline and summary characteristics of the studies were extracted. A bivariate random-effects model was used to pool diagnostic accuracy estimates, and heterogeneity and publication bias were evaluated. Sensitivity analyses were performed using the leave-one-out method to assess the robustness of the findings. The Quality Assessment of Diagnostic Accuracy Studies-2 tool assessed bias risk.

resultsTen studies involving 697 pediatric patients met the inclusion criteria. The pooled sensitivity of POCUS for confirming endotracheal placement was 0.95 (95% CI: 0.88-0.98; I² = 84.6%), and specificity was 0.70 (95% CI: 0.34-0.92; I² = 84.5%). The pooled DOR was 37.14 (95% CI: 6.17-223.47), and the AUC was 0.95 (95% CI: 0.91-0.99). Time to adequate ETT visualization was 45.8 s, the pooled procedural success rate was 97% (95% CI: 80-100%), and the reintubation rate was 2% (95% CI: 1-4%).

conclusionPOCUS is a highly sensitive, rapid, radiation-free, and feasible adjunct method for confirming endotracheal placement in critically ill pediatric patients. This integration could reduce the risk of complications associated with ETT misplacement, thereby improving patient outcomes. This meta-analysis finds that POCUS is a highly sensitive adjunct for confirming pediatric ETT placement. However, the pooled specificity was only moderate, and significant heterogeneity across studies in populations, settings, and techniques was a major finding. This variability currently limits its utility as a standalone test. Our results underscore the need for standardized protocols and operator training to improve specificity and consistency before POCUS can be more broadly relied upon for this critical task.