Study of Ethics & Law: Analysis of Lawsuits Related to Diagnostic Errors from Point-of-Care Ultrasound in Internal Medicine, Pediatrics, Family Medicine and Critical Care in the USA.

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Analysis of Lawsuits Related to Diagnostic Errors from Point-of-Care Ultrasound in Internal Medicine, Pediatrics, Family Medicine and Critical Care in the USA

Source: Postgrad Med J 2020;0:1–4


Point-of-care ultrasound (POCUS) provides the clinician with a real-time, dynamic look at the patients’ vital organ systems and can be used to evaluate a plethora of physiologic parameters. POCUS can be very useful even in the hands of novice users, when it is used to enhance the physical examination and diagnose some of the most life-threatening conditions.

As adoption of this technology continues to increase, there are some concerns regarding the potential for lawsuits related to its use in clinical practice.

The implementation of POCUS into the broad range of medical specialties has varied greatly. Emergency medicine (EM) is a leading specialty in POCUS integration, with the introduction into the specialty in the 1980s and guidelines for POCUS use in the field dating back to 2001. There is increased concern for litigation related to potential misdiagnoses and inappropriate treatments with increase in POCUS use by EM physicians. In addition, there is also concern for liability from the failure to perform POCUS in indicated situations. These concerns are also true in the fields of neonatology and pediatric subspecialties.

This study aimed to identify the extent and prevalence of diagnostic error lawsuits related to POCUS use in internal medicine (IM), pediatrics, family medicine (FM) and critical care medicine (CCM).


This is a retrospective review of the Westlaw legal database for indexed state and federal lawsuits related to diagnostic errors in use of POCUS within IM, pediatrics, FM and CCM. The Westlaw database is a restricted, online legal resource that includes state and federal lawsuits dating back to 1939. The authors queried Westlaw for all state and federal cases on 1 October 2019.

The search revealed 131 cases that were then reviewed for applicability to the research question. To determine relevance to our study objective and whether or not the use of POCUS was material to the substance of the lawsuit, cases were reviewed using a pre-defined algorithm.

Cases relevant to the study objective would include POCUS for diagnostic use by clinicians in IM, pediatrics, FM or CCM where the use of POCUS was material to the lawsuit. Obstetrical ultrasounds were excluded although these may be performed by FM practitioners. All retrieved cases were reviewed independently by three physicians.


The study results suggest that POCUS use in the fields of IM, pediatrics, FM and CCM has been an unlikely source of lawsuits. Physicians’ perceptions of their risk of liability impacts clinical practice, and therefore, uncovering the potential for litigation due to the implementation of POCUS is an important issue. Concerns about facing a lawsuit as a result of POCUS use has the potential to negatively affect the implementation of POCUS by clinicians. This, in turn, could limit its overall benefits on a population level.

This is even more apparent in the concerns voiced by educational leadership, citing the potential for litigation as a barrier to implementing POCUS training in their programs.

The authors concluded that results of this study provide clinicians with reliable data to make this determination based on evidence as opposed to perception and unsupported fear of legal liability.