Original Contribution
Point-of-care hip ultrasound in a pediatric emergency department☆

https://doi.org/10.1016/j.ajem.2017.11.059Get rights and content

Introduction

Pediatric Emergency Medicine (PEM) physicians are often faced with the diagnostic challenge of evaluating patients with limp, hip pain, or refusal to bear weight. Identification of a hip effusion by ultrasound (US) at the bedside may narrow the differential diagnosis, and may raise the suspicion for septic arthritis, an emergent condition requiring immediate intervention.

Historically, radiologists have performed hip US on pediatric emergency department (ED) patients [1]. However, use of point-of-care ultrasound (POCUS) is becoming increasingly common in PEM [2], [3], [4]. It is an attractive imaging modality because it is quick, noninvasive, portable, lacks radiation exposure, and provides important diagnostic information in real-time at the bedside. An important application of POCUS is hip ultrasonography, and quickly identifying a joint effusion can expedite diagnosis, management, and disposition in the appropriate clinical setting. Understanding the test characteristics of PEM-physician performed hip POCUS is important because it is a relatively new application and current evidence is limited.

We performed a retrospective study to evaluate the test characteristics of PEM-physician performed hip POCUS to identify hip effusions in pediatric emergency department patients and to determine the association between ultrasound accuracy and sonographer experience.

Section snippets

Study design and setting

This is a retrospective cohort study of PEM-physician performed POCUS hip studies to identify the presence or absence of a hip effusion. Bedside hip POCUS was performed by either PEM fellow or attending physicians on pediatric patients presenting to the ED of a tertiary-care, level I trauma, freestanding pediatric hospital. The ED serves a primarily urban and suburban population and has an annual census of approximately 60,000 visits per year. The Division of Emergency Medicine has four

Baseline characteristics

The characteristics of patients on whom hip POCUS were performed are shown in Table 1. During the study period, 926 hip POCUS exams were performed in 516 patients by 72 different PEM providers, which included 42 PEM attending physicians and 30 PEM fellow physicians. Forty-one studies were excluded because the corresponding hip POCUS images and video clips were unavailable.

Primary outcomes

Overall, PEM physician-performed hip POCUS had a sensitivity of 85% (95% confidence interval [CI] 79 to 89) and a

Discussion

To our knowledge, the present study is the largest to date demonstrating the test characteristics of PEM physician-performed hip POCUS. Here we show that PEM physician-performed hip POCUS has outstanding test characteristics. Approximately two-thirds of the hip POCUS hip exams in this study were clinically-indicated; analyzing only these clinically-indicated studies demonstrated similarly strong test characteristics. With adequate training, we believe hip POCUS performed by a PEM physician has

Conclusions

PEM physician-performed hip POCUS has excellent test characteristics, and increased experience results in increased accuracy. Larger prospective studies at other institutions may be indicated to validate our results.

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References (18)

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Cited by (10)

  • Yield of Plain Radiography in Addition to Ultrasound Among Children with Hip Pain

    2021, Journal of Emergency Medicine
    Citation Excerpt :

    Previous studies have shown that POCUS can be used to identify hip effusions and aid in the evaluation of patients presenting to the ED with hip pain (5–9). PEM physician-performed hip POCUS has been shown to have excellent test characteristics, with a sensitivity and negative predictive value of 86% and 93%, respectively, and a specificity and positive predictive value of 96% and 91%, respectively (5). In this study, the majority of patients (73%, n = 173) received POCUS studies performed by PEM physicians.

  • Procedural Applications of Point-of-Care Ultrasound in Pediatric Emergency Medicine

    2021, Emergency Medicine Clinics of North America
    Citation Excerpt :

    One PED has demonstrated that pediatric emergency medicine physicians43 and fellows43,44 can diagnose hip effusions accurately with POCUS through a small prospective sample43 and larger retrospective cohort44 of pediatric patients (sensitivity 80%–85% and specificity 98%). Test accuracy improved with increasing provider experience (2.4% increased odds of accurate scan per additional study performed)44 and when provider confidence in the POCUS result was high (sensitivity 90% and specificity 100%).43 POCUS-guided hip aspiration performed in the ED by emergency physicians has been described in both pediatric45 and adult case series.46,47

  • Point-of-Care Ultrasound and the Septic Prosthetic Hip Joint

    2019, Journal of Emergency Medicine
    Citation Excerpt :

    Visualization of fluid by ultrasound can also prevent unnecessary “dry” aspirations and joint contamination. Other case reports have illustrated the role of POCUS in the emergency department for pediatric and adult native hips (6–8,15). Here we present a case where POCUS too can be utilized with prosthetic hip joints to evaluate for an effusion.

  • Evaluating the child with a limp

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    2023, Diagnostics

  • Establishing the international research priorities for pediatric emergency medicine point-of-care ultrasound: A modified Delphi study

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Conflicts of interest: none.

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