443 - Accuracy of Pediatric Emergency Medicine Providers in Identifying Hip Effusions Using Point of Care Ultrasound

Sunday, April 30, 2023

3:30 PM – 6:00 PM ET

Poster Number: 443
Publication Number: 443.312

Ruchika M. Jones, University of Connecticut School of Medicine, Suffield, CT, United States; Laurie Malia, Columbia University Vagelos College of Physicians and Surgeons, New York, NY, United States; Peter J. Snelling, Gold Coast University Hospital, Southport, Queensland, Australia; William Mak, Cohen Children's Medical Center, New Hyde Park, NY, United States; Antonio Riera, Yale University, Westport, CT, United States; Douglas Moote, Connecticut Children's Medical Center, Hartford, CT, United States; Henry Chicaiza, Connecticut Children's Medical Center, Suffield, CT, United States; Adam Sivitz, Children's Hospital of New Jersey- Newark Beth Israel Medical Center; Michael Brimacombe, Connecticut Children's Medical Center, Hartford, CT, United States

Presenting Author(s)

RJ

Ruchika M. Jones, MD, MS (she/her/hers)

Attending Physician
University of Connecticut School of Medicine
Suffield, Connecticut, United States

Background: The use of ultrasonography is well documented in the diagnostic evaluation of children with hip pain, limp, and refusal to bear weight. The current reference standard for diagnosis of hip effusion is an ultrasound performed by the department of radiology. There is limited data on the accuracy of point-of-care ultrasound (POCUS) performed by pediatric emergency medicine (PEM) providers to identify a hip effusion.

Objective:

To determine that the accuracy of POCUS trained PEM providers to diagnose hip effusion using POCUS is non-inferior to the reference standard of radiology performed ultrasound.

Design/Methods: This is a prospective, multi-center, international, non-inferiority, diagnostic study. A convenience sample of children 18 and younger presenting to the emergency department (ED) with a chief complaint requiring hip ultrasonography as part of their clinical evaluation was enrolled. Pediatric emergency medicine attendings and fellows with prior training in hip ultrasonography performed a point-of-care ultrasound of affected and unaffected hips. Physicians categorized their findings as “yes” or “no” for presence of effusion. The size of effusion was measured at two sites, the first at the anterior portion of the femoral neck which has been documented in the current literature. The second along the angle of the femoral neck to compare with currently held definitions. Each patient also underwent ultrasound performed by the department of radiology. PEM physicians were blinded to radiology results. POCUS results were compared to the department of radiology results.

Results:

120 participants were consented and enrolled in the study. 240 hips were evaluated. 35.8% of participants were female and 64.2% were male. Average age was 5.1 years (SD 3.4). In both affected and unaffected hips, POCUS had a sensitivity of 90% (95% confidence interval [CI] 79% to 96%), a specificity of 99% (95% CI 96% to 100%), a positive predictive value of 96% (95% CI 86% to 99%), a negative predictive value of 97% (95% CI 93% to 99%). In the 120 affected hips, POCUS had sensitivity of 95% (95% CI 84% to 99%), a specificity of 97% (95% CI 88% to 99%), a positive predictive value of 96% (95% CI 86% to 99%), and a negative predictive value of 95% (95% CI 86% to 99%). Location of measurement along the femoral neck did not affect the ultimate diagnosis.

Conclusion(s): Pediatric emergency medicine physicians with training can diagnose hip effusions in pediatric patients using point-of-care ultrasound.