Halm Brunhild M, Leone Tina A, Chaudoin Lindsey T, McKinley Kenneth W, Ruzal-Shapiro Carrie, Franke Adrian A, Tsze Daniel S
From the Departments of Pediatrics.
Neonatology.
Pediatr Emerg Care. 2021 Feb 1;37(2):77-81. doi: 10.1097/PEC.0000000000001497.
The identification of hydrocephalus in infants by pediatric emergency medicine (PEM) physicians using cranial point-of-care ultrasound (POCUS) has not been evaluated. We aimed to conduct a pilot/proof-of-concept study to evaluate whether PEM physicians can identify hydrocephalus (anterior horn width >5 mm) in 15 infants (mean 69 ± 42 days old) from the neonatal intensive care unit using POCUS. Our exploratory aims were to determine the test characteristics of cranial POCUS performed by PEM physicians for diagnosing hydrocephalus and the interrater reliability between measurements made by the PEM physicians and the radiologist.
Depending on the availability, 1 or 2 PEM physicians performed a cranial POCUS through the open anterior fontanel for each infant after a 30-minute didactic lecture to determine the size of the left and right ventricles by measuring the anterior horn width at the foramen of Monroe in coronal view. Within 1 week, an ultrasound (US) technologist performed a cranial US and a radiologist determined the ventricle sizes from the US images; these measurements were the criterion standard.
A radiologist determined 12 of the 30 ventricles as hydrocephalic. The sensitivity and specificity of the PEM physicians performed cranial POCUS was 66.7% (95% confidence interval [CI], 34.9%-90.1%) and 94.4% (95% CI, 72.7%-99.9%), whereas the positive and negative predictive values were 88.9% (95% CI, 53.3%-98.2%) and 81.0% (95% CI, 65.5%-90.5%), respectively. The interrater reliability between the PEM physician's and radiologist's measurements was r = 0.91. The entire POCUS examinations performed by the PEM physicians took an average of 1.5 minutes. The time between the cranial POCUS and the radiology US was, on average, 4 days.
While the PEM physicians in our study were able to determine the absence of hydrocephalus in infants with high specificity using cranial POCUS, there was insufficient evidence to support the use of this modality for identifying hydrocephalus. Future studies with more participants are warranted to accurately determine test characteristics.
尚未评估儿科急诊医学（PEM）医生使用颅床旁超声（POCUS）对婴儿脑积水进行识别的情况。我们旨在开展一项试点/概念验证研究，以评估PEM医生能否使用POCUS识别新生儿重症监护病房中15名婴儿（平均年龄69±42天）的脑积水（前角宽度>5mm）。我们的探索性目标是确定PEM医生进行颅POCUS诊断脑积水的检测特征，以及PEM医生与放射科医生测量结果之间的观察者间可靠性。
根据可用性，1名或2名PEM医生在进行30分钟的理论授课后，通过开放的前囟门对每名婴儿进行颅POCUS检查，通过在冠状视图下测量Monro孔处的前角宽度来确定左右心室大小。在1周内，超声（US）技术人员进行颅部超声检查，放射科医生根据US图像确定心室大小；这些测量结果为标准对照。
放射科医生确定30个心室中有12个为脑积水。PEM医生进行颅POCUS检查的敏感性和特异性分别为66.7%（95%置信区间[CI]，34.9%-90.1%）和94.4%（95%CI，72.7%-99.9%），而阳性和阴性预测值分别为88.9%（95%CI，53.3%-98.2%）和81.0%（95%CI，65.5%-90.5%）。PEM医生与放射科医生测量结果之间的观察者间可靠性为r = 0.91。PEM医生进行的整个POCUS检查平均耗时1.5分钟。颅POCUS检查与放射科超声检查之间的时间平均为4天。
虽然我们研究中的PEM医生能够使用颅POCUS以高特异性确定婴儿不存在脑积水，但没有足够证据支持使用这种方式识别脑积水。有必要开展更多参与者的未来研究以准确确定检测特征。
