Katz-Dana Hadas, Stackievicz Rudica, Dana Elad, Friedman Nir, Lackner Gali, Rosenbloom Ehud, Shles Ayelet
Pediatric Emergency Department, Meir Medical Center, Kfar Saba, Israel.
School of Medicine, Tel Aviv University, Tel Aviv, Israel.
CJEM. 2024 Dec;26(12):875-882. doi: 10.1007/s43678-024-00788-z. Epub 2024 Oct 1.
A new limp or refusal to weight-bear are common symptoms in children presenting to the pediatric emergency department (ED). This poses a diagnostic challenge, particularly among toddlers and nonverbal patients. Point-of-care ultrasound (PoCUS) used by pediatric emergency medicine physicians may detect hip effusion, which dramatically aids diagnostic workup and management. There is limited literature regarding the accuracy of hip PoCUS conducted by pediatric emergency medicine physicians. This study aims to assess the diagnostic performance of pediatric emergency medicine physician-performed PoCUS in identifying hip effusion.
This prospective study was conducted in a single-center pediatric ED. Children presenting with limb pain or new limp were evaluated by pediatric emergency medicine physicians who also performed hip PoCUS and categorized findings as either "effusion" or "no effusion" based on standard sonographic definitions. Patients also underwent radiology department ultrasound reviewed by a pediatric radiologist. Diagnostic test characteristics with corresponding 95% confidence intervals (CI) were calculated using radiology department ultrasound findings as the reference standard.
A total of 95 patients were enrolled by 8 pediatric emergency medicine physicians. Excellent agreement was observed between PoCUS performed by pediatric emergency medicine physicians and radiology department ultrasound for the presence or absence of hip effusion (kappa = 0.81 [95% CI 0.70-0.93]). Hip effusion was identified by PoCUS in 44 out of 49 effusion-positive patients, with a sensitivity of 89.8% (95% CI 77.7-96.6%), specificity of 91.3% (95% CI 79.2%-97.5%), positive likelihood ratio of 10.33 (95% CI 4.03-26.47), and negative likelihood ratio of 0.11 (95% CI 0.05-0.26).
PoCUS performed by pediatric emergency medicine physicians has reasonably high sensitivity and specificity for diagnosing hip effusion among pediatric patients presenting to the pediatric ED with a limp or leg pain. This practice may potentially expedite both diagnosis and treatment within this patient population.
新发跛行或拒绝负重是儿科急诊科就诊儿童的常见症状。这带来了诊断挑战，尤其是在幼儿和无法言语的患者中。儿科急诊医学医生使用的床旁超声（PoCUS）可能检测到髋关节积液，这对诊断检查和管理有极大帮助。关于儿科急诊医学医生进行髋关节PoCUS检查准确性的文献有限。本研究旨在评估儿科急诊医学医生进行的PoCUS在识别髋关节积液方面的诊断性能。
本前瞻性研究在单中心儿科急诊科进行。出现肢体疼痛或新发跛行的儿童由儿科急诊医学医生进行评估，这些医生还进行髋关节PoCUS检查，并根据标准超声定义将检查结果分类为“积液”或“无积液”。患者还接受了儿科放射科医生对放射科超声检查的复查。以放射科超声检查结果作为参考标准，计算诊断试验特征及相应的95%置信区间（CI）。
8名儿科急诊医学医生共纳入95例患者。儿科急诊医学医生进行的PoCUS检查与放射科超声检查在髋关节积液有无方面的一致性良好（kappa = 0.81 [95% CI 0.70 - 0.93]）。在49例积液阳性患者中，PoCUS检查发现44例有髋关节积液，灵敏度为89.8%（95% CI 77.7 - 96.6%），特异度为91.3%（95% CI 79.2% - 97.5%），阳性似然比为10.33（95% CI 4.03 - 26.47），阴性似然比为0.11（95% CI 0.05 - 0.26）。
儿科急诊医学医生进行的PoCUS检查在诊断因跛行或腿痛就诊于儿科急诊科的儿科患者髋关节积液方面具有相当高的灵敏度和特异度。这种做法可能会加快该患者群体的诊断和治疗。
