Utilization of point-of-care ultrasound and associated factors among emergency physicians in Henan Province, China: a multicenter cross-sectional survey.

Background: Real-world evidence on point-of-care ultrasound (POCUS) utilization and its correlates among emergency physicians remains limited in China. This study assessed POCUS use, practice patterns, training and perceived competence in Henan Province and examined physician- and hospital-level factors associated with POCUS utilization. Methods: A multicenter cross-sectional questionnaire survey was conducted in Henan Province from 1 October to 15 November 2025 among emergency physicians with at least 3 years of ED experience from a targeted network of 278 public secondary and tertiary general hospitals. We compared characteristics between POCUS users and non-users and used logistic regression to identify factors associated with POCUS use, with sensitivity analyses further adjusting for hospital bed size and annual emergency department volume. Results: Of 1,020 physicians who accessed the survey, 2 did not provide informed consent, leaving 1,018 respondents for analysis. Overall, 569 physicians (55.9%) reported any current POCUS use and 449 (44.1%) reported no POCUS use. Among non-users, the leading barriers were lack of an ultrasound machine (300, 66.8%) and lack of POCUS skills (160, 35.6%). Among respondents reporting POCUS use, the most common applications were basic procedural guidance (453, 79.6%) and FAST or extended FAST (423, 74.4%). Self-rated competence was modest, with 260 (45.7%) rating skills as fair and 201 (35.4%) as poor or very poor. Use during cardiac arrest was uncommon: 84 (14.8%) never used POCUS and 136 (23.9%) used it often or always. In the primary multivariable model, educational level (adjusted OR 2.06 per one-category increase, 95% CI 1.52-2.79), tertiary hospital status (adjusted OR 1.60, 95% CI 1.16-2.20), and teaching hospital status (adjusted OR 2.03, 95% CI 1.54-2.69) were associated with POCUS use. In sensitivity analyses, hospital bed size and emergency department volume were strongly associated with POCUS use, and tertiary hospital status was no longer statistically significant. Conclusion: POCUS was commonly reported among emergency physicians in Henan Province, but adoption was constrained by equipment and training gaps, with particularly low use during cardiac arrest. Institutional capacity appears to be an important correlate of POCUS uptake, supporting combined strategies of equipment provision and scalable competency-based training.