Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

Abstract Background: This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage. Methods: This retrospective study included 1-month- to 6-year-old children who underwent POCUS for the detection of intussusception in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to lower standards wherein POCUS was performed in the presence of any one of the following symptoms: intermittent abdominal pain, bloody stool, ≥2 causes of nonspecific abdominal pain, abdominal mass, vomiting, or lethargy. POCUS results were interpreted and categorized as “negative” or “suspicious,” and a radiologist performed confirmatory ultrasound in “suspicious” cases. Results: We analyzed 575 POCUS scans from 549 patients (mean age, 25.5 months). Among the 92 “suspicious” cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7 hours, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain (P < 0.001), but less vomiting (P = 0.001); the other clinical features showed no intergroup differences. Conclusion: POCUS performed using the criteria set to lower standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.

Download Full-text

Point-of-Care Ultrasound May Be Useful for Detecting Pediatric Intussusception at an Early Stage

10.21203/rs.2.17852/v2 ◽

2020 ◽

Author(s):

Jeong-Yong Lee ◽

Jung Heon Kim ◽

Seung Jun Choi ◽

Jong Seung Lee ◽

Jeong-Min Ryu

Keyword(s):

Abdominal Pain ◽

Early Stage ◽

Point Of Care ◽

Abdominal Mass ◽

Pediatric Emergency ◽

Symptom Duration ◽

Point Of Care Ultrasound ◽

Bloody Stool ◽

Emergency Physicians ◽

Intermittent Abdominal Pain

Abstract Background: This study aimed to verify the usefulness of point-of-care ultrasound (POCUS) performed by pediatric emergency physicians for detecting intussusception at an early stage. Methods: This retrospective study included 1-month- to 6-year-old children with clinically suspected intussusception, who underwent POCUS in the pediatric emergency department between December 2016 and February 2018. The criteria for performing POCUS were set to broader standards: presenting any one of intermittent abdominal pain/irritability or bloody stool, or ≥2 symptoms among nonspecific abdominal pain/irritability, abdominal mass/distension, vomiting, or lethargy. POCUS results were interpreted and categorized as “negative” or “suspicious,” and a radiologist performed confirmatory ultrasound in “suspicious” cases. Results: We analyzed 575 POCUS scans from 549 patients (mean age, 25.5 months). Among the 92 “suspicious” cases (16.0%), 70 (12.2%) were confirmed to have intussusception. POCUS showed 100% sensitivity, 95.6% specificity, and 97.8% accuracy. Patients with confirmed intussusception were mainly diagnosed in the early stages, with a mean symptom duration of 11.7 hours, and most patients (97.1%) were treated successfully via air enema reduction. Compared to the non-intussusception group, the intussusception group had more intermittent abdominal pain ( P < 0.001), but less vomiting ( P = 0.001); the other clinical features showed no intergroup differences. Conclusion: POCUS performed using the criteria set to broader standards by pediatric emergency physicians may be useful for detecting intussusception at an early stage, which may present with obscure clinical symptoms.

Download Full-text

Accuracy of point-of-care ultrasound by pediatric emergency physicians for testicular torsion

Journal of Pediatric Urology ◽

10.1016/j.jpurol.2019.07.003 ◽

2019 ◽

Vol 15 (6) ◽

pp. 608.e1-608.e6 ◽

Cited By ~ 4

Author(s):

N. Friedman ◽

Z. Pancer ◽

R. Savic ◽

F. Tseng ◽

M.S. Lee ◽

...

Keyword(s):

Testicular Torsion ◽

Point Of Care ◽

Pediatric Emergency ◽

Point Of Care Ultrasound ◽

Emergency Physicians

Download Full-text

Reliability of Neck Mass Point‐of‐Care Ultrasound by Pediatric Emergency Physicians

Journal of Ultrasound in Medicine ◽

10.1002/jum.14993 ◽

2019 ◽

Vol 38 (11) ◽

pp. 2893-2900 ◽

Cited By ~ 1

Author(s):

Nir Friedman ◽

Felicia Tseng ◽

Ranko Savic ◽

Mamadou Diallo ◽

Kate Fathi ◽

...

Keyword(s):

Point Of Care ◽

Pediatric Emergency ◽

Neck Mass ◽

Mass Point ◽

Point Of Care Ultrasound ◽

Emergency Physicians

Download Full-text

Emergency point-of-care ultrasound in Canadian pediatric emergency fellowship programs: current integration and future directions

CJEM ◽

10.1017/cem.2016.20 ◽

2016 ◽

Vol 18 (6) ◽

pp. 469-474 ◽

Cited By ~ 5

Author(s):

Julia Hoeffe ◽

Marie Pier Desjardins ◽

Jason Fischer ◽

Benoit Carriere ◽

Jocelyn Gravel

Keyword(s):

Point Of Care ◽

Program Directors ◽

Pediatric Emergency ◽

Point Of Care Ultrasound ◽

Emergency Physicians ◽

Future Directions ◽

Current Implementation ◽

Fellowship Programs ◽

Future Direction ◽

Standardized Curriculum

AbstractBackgroundAdult and pediatric emergency physicians have been using point-of-care ultrasound (POCUS) for many years. It is a fast, usually painless, noninvasive diagnostic tool that does not expose the patient to radiation. Information about its current implementation in pediatric emergency medicine (PEM) fellowship programs in Canada is lacking.ObjectiveThe main goal of our study was to investigate current integration and future direction of POCUS training in Canadian PEM programs.MethodsThe study consisted of two surveys designed for fellows and program directors of all Canadian PEM fellowship programs. The major aspects of the survey were 1) to describe current training in POCUS in fellowship programs, 2) to compare the kind of training that programs offer with what fellows actually receive, and 3) a needs assessment by fellows and program directors for future POCUS training programs. Surveys were sent to program directors and passed on to their fellows.ResultsNinety percent of fellowship program directors as well as 70% (42/60) of fellows responded to the survey. A formal POCUS curriculum exists in five of the nine PEM programs included in this study. Three programs offer specific pediatric POCUS training. The main application is the FAST (focused assessment with sonography for trauma) exam.ConclusionThere is a wide variation in POCUS content and delivery across PEM fellowship programs, as well as differences in perceptions of current training and of needs by fellows and program directors. However, given that both groups feel POCUS is very important and essential for PEM training, the opportunity exists to develop a standardized curriculum across Canada.

Download Full-text

Point-of-care ultrasound for evaluating intra-abdominal calcification in the pediatric emergency department: case series and review of literature

The Ultrasound Journal ◽

10.1186/s13089-020-00199-y ◽

2020 ◽

Vol 12 (1) ◽

Author(s):

Vigil James ◽

John Samuel ◽

Chor Yek Kee ◽

Gene Yong-Kwang Ong

Keyword(s):

Emergency Department ◽

Differential Diagnosis ◽

Abdominal Pain ◽

Acute Abdominal Pain ◽

Point Of Care ◽

Pediatric Population ◽

Pediatric Emergency ◽

Point Of Care Ultrasound ◽

Pediatric Emergency Department ◽

Wall Calcification

Abstract Background The presence of intra-abdominal calcification in the pediatric population can be due to a wide range of conditions. Calcification in the abdomen can be seen in normal or abnormal anatomical structures. In some patients, abnormal calcification points towards the pathology; whereas in others, calcification itself is the pathology. After a thorough history and clinical examination, point-of-care ultrasound (POCUS) would complement the assessment of acute abdominal pain, based on the list of differentials generated as per the abdominal region. The main objective of this article is to review commonly encountered causes of intra-abdominal calcifications in the pediatric population and help in clinical decision-making in a Pediatric Emergency Department. Case presentation We describe a series of pediatric patients who presented to the Pediatric Emergency Department with acute abdominal pain, in whom point-of-care ultrasound helped expedite the diagnosis by identifying varying types of calcification and associated sonological findings. For children who present to the Pediatric Emergency Department with significant abdominal pain, a rapid distinction between emergencies and non-emergencies is vital to decrease morbidity and mortality. Conclusions In a child presenting to the Pediatric Emergency Department with abdominal pain, POCUS and the findings of calcifications can narrow or expand the differential diagnosis when integrated with history and physical exam, to a specific anatomic structure. Integrating these findings with additional sonological findings of an underlying pathology might raise sufficient concerns in the emergency physicians to warrant further investigations for the patient in the form of a formal radiological ultrasound and assist in the patient's early disposition. The use of POCUS might also help to categorize the type of calcification to one of the four main categories of intra-abdominal calcifications, namely concretions, conduit wall calcification, cyst wall calcification, and solid mass-type calcification. POCUS used thoughtfully can give a diagnosis and expand differential diagnosis, reduce cognitive bias, and reduce physician mental load. By integrating the use of POCUS with the history and clinical findings, it will be possible to expedite the management in children who present to the Pediatric Emergency Department with acute abdominal pain.

Download Full-text

Bedside Point-of-Care Ultrasound of an Adult with Diffuse Intermittent Abdominal Pain

Acute Medicine Journal ◽

10.52964/amja.0798 ◽

2020 ◽

Vol 19 (1) ◽

pp. 49-51

Author(s):

Jamaji C Nwanaji-Enwerem ◽

◽

Adaira Landry ◽

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Point Of Care ◽

Sudden Onset ◽

Point Of Care Ultrasound ◽

Intermittent Abdominal Pain ◽

Obesity Status ◽

History Of ◽

History Of Obesity ◽

New Onset

A 29-year-old woman with a history of obesity status post Roux-en-Y gastric bypass greater than five years prior presented to the emergency department with four hours of sudden-onset stabbing left-sided abdominal pain associated with nausea and non-bloody emesis. She denied melaena and hematochezia, but did report two weeks of diarrhoea that was unchanged with this new onset abdominal pain.

Download Full-text

Timely Diagnosis of Pneumoperitoneum by Point-of-care Ultrasound in the Emergency Department: A Case Series

Clinical Practice and Cases in Emergency Medicine ◽

10.5811/cpcem.2021.4.52139 ◽

2021 ◽

Vol 5 (4) ◽

pp. 377-380

Author(s):

Jung Yum ◽

Taryn Hoffman ◽

Leily Naraghi

Keyword(s):

Emergency Department ◽

Abdominal Pain ◽

Elderly Patients ◽

Point Of Care ◽

Case Series ◽

Point Of Care Ultrasound ◽

Emergency Physicians ◽

Hollow Viscus ◽

Timely Diagnosis ◽

Life Threatening

Introduction: Pneumoperitoneum is a life-threatening diagnosis that requires timely diagnosis and action. We present a case series of patients with perforated hollow viscus who were accurately diagnosed by emergency physicians using point-of-care ultrasound (POCUS) while in the emergency department (ED). Case Series: Three elderly patients presented to the ED with the complaints of syncope, abdominal pain with constipation, and unresponsiveness. The emergency physicians used POCUS to diagnose and then expedite the necessary treatment. Conclusion: Point-of-care ultrasound can be used by emergency physicians to diagnose pneumoperitoneum in the ED.

Download Full-text

Point-of-Care Ultrasound in the Diagnosis of Acute Abdominal Pain

Operative Techniques and Recent Advances in Acute Care and Emergency Surgery ◽

10.1007/978-3-319-95114-0_27 ◽

2019 ◽

pp. 383-401

Author(s):

Francesca Cortellaro ◽

Cristiano Perani ◽

Linda Guarnieri ◽

Laura Ferrari ◽

Michela Cazzaniga ◽

...

Keyword(s):

Abdominal Pain ◽

Acute Abdominal Pain ◽

Point Of Care ◽

Point Of Care Ultrasound

Download Full-text

Fabry Cardiomyopathy: Current Practice and Future Directions

Cells ◽

10.3390/cells10061532 ◽

2021 ◽

Vol 10 (6) ◽

pp. 1532

Author(s):

Jeffrey Yim ◽

Olivia Yau ◽

Darwin F. Yeung ◽

Teresa S. M. Tsang

Keyword(s):

Fabry Disease ◽

Early Stage ◽

Point Of Care ◽

Left Ventricular ◽

The Body ◽

Cardiac Biomarkers ◽

Dried Blood Spot ◽

Point Of Care Ultrasound ◽

Enzyme Replacement ◽

Blood Spot

Fabry disease (FD) is an X-linked lysosomal storage disorder caused by mutations in the galactosidase A (GLA) gene that result in deficient galactosidase A enzyme and subsequent accumulation of glycosphingolipids throughout the body. The result is a multi-system disorder characterized by cutaneous, corneal, cardiac, renal, and neurological manifestations. Increased left ventricular wall thickness represents the predominant cardiac manifestation of FD. As the disease progresses, patients may develop arrhythmias, advanced conduction abnormalities, and heart failure. Cardiac biomarkers, point-of-care dried blood spot testing, and advanced imaging modalities including echocardiography with strain imaging and magnetic resonance imaging (MRI) with T1 mapping now allow us to detect Fabry cardiomyopathy much more effectively than in the past. While enzyme replacement therapy (ERT) has been the mainstay of treatment, several promising therapies are now in development, making early diagnosis of FD even more crucial. Ongoing initiatives involving artificial intelligence (AI)-empowered interpretation of echocardiographic images, point-of-care dried blood spot testing in the echocardiography laboratory, and widespread dissemination of point-of-care ultrasound devices to community practices to promote screening may lead to more timely diagnosis of FD. Fabry disease should no longer be considered a rare, untreatable disease, but one that can be effectively identified and treated at an early stage before the development of irreversible end-organ damage.

Download Full-text