TRAUMA:
- A systemic review/meta-analysis concluded that ultrasound had a sensitivity of 91% and specificity of 96% for skull fractures after pediatric blunt head trauma. Positive and negative likelihood ratios were 14.4 and 0.14, respectively.
- Gordon I, Sinert R, Chao J. The Utility of Ultrasound in Detecting Skull Fractures After Pediatric Blunt Head Trauma: Systematic Review and Meta-Analysis. Pediatr Emerg Care. 2020 Feb 28. doi: 10.1097/PEC.0000000000001958. Epub ahead of print. PMID: 32118837.
- Focused Assessment of Sonography (FAST) has low sensitivity and high specificity for clinically important free fluid in children with blunt abdominal trauma. A prospective observational study found ultrasound was 52% sensitive and 96% specific for significant hemoperitoneum with positive likelihood ratio 13.4 and negative likelihood ratio 0.5.
- Fox JC, Boysen M, Gharahbaghian L, Cusick S, Ahmed SS, Anderson CL, Lekawa M, Langdorf MI. Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med. 2011 May;18(5):477-82. doi: 10.1111/j.1553-2712.2011.01071.x. PMID: 21569167.
PAPILLEDEMA/INCREASED INTRACRANIAL PRESSURE:
- In addition to optic nerve sheath diameter, a case series with four pediatric patients identified two other optic nerve abnormalities for papilledema seen with point-of-care ultrasound: optic disc elevation and the crescent sign. All four patients with papilledema had optic nerve elevation, which was defined as 1 mm or greater above the retina. One of the four patients with papilledema also had fluid surrounding the optic nerve, which appeared as a crescent shape adjacent to the optic nerve when viewed in a transverse orientation.
- Marchese RF, Mistry RD, Scarfone RJ, Chen AE. Identification of optic disc elevation and the crescent sign using point-of-care ocular ultrasound in children. Pediatr Emerg Care. 2015 Apr;31(4):304-7. doi: 10.1097/PEC.0000000000000408. PMID: 25831036.
- Ocular ultrasound performed by emergency physicians accurately detected clinically apparent optic disc swelling. A blinded, prospective study using a population of children referred by a neuro-ophthalmology clinic for risk of conditions associated with optic disc edema found optic disc height > 0.6 mm 82% sensitive and 76% specific, and height >1 mm 73% sensitive and 100% specific, for optic disc edema noted on fundoscopic examination.
- Teismann N, Lenaghan P, Nolan R, Stein J, Green A. Point-of-care ocular ultrasound to detect optic disc swelling. Acad Emerg Med. 2013 Sep;20(9):920-5. doi: 10.1111/acem.12206. PMID: 24050798.
PNEUMONIA
- Meta-analysis concluding that lung ultrasound for diagnosis of pneumonia in children had a sensitivity of 96% and specificity of 93%. Positive and negative likelihood ratios were 15.3 and 0.06, respectively.
- Pereda MA, Chavez MA, Hooper-Miele CC, Gilman RH, Steinhoff MC, Ellington LE, Gross M, Price C, Tielsch JM, Checkley W. Lung ultrasound for the diagnosis of pneumonia in children: a meta-analysis. Pediatrics. 2015 Apr;135(4):714-22. doi: 10.1542/peds.2014-2833. Epub 2015 Mar 16. PMID: 25780071.
FLUID STATUS
- Ultrasound-measured IVC/Aorta ratio is a modest predictor of significant dehydration in children. A ratio of 0.8 or less had a sensitivity of 67% and specificity of 71% for diagnosis of significant dehydration, which was defined as a percentage weight increase of 10% from initial presentation to discharge. Additionally, inspiratory IVC collapse and physician gestalt were found to be poor predictors of dehydration.
- Jauregui J, Nelson D, Choo E, Stearns B, Levine AC, Liebmann O, Shah SP. The BUDDY (Bedside Ultrasound to Detect Dehydration in Youth) study. Crit Ultrasound J. 2014 Sep 10;6(1):15. doi: 10.1186/s13089-014-0015-z. PMID: 25411590; PMCID: PMC4233328.
- Ultrasound-measured IVC/Aorta ratio correlates with significant dehydration in children with gastroenteritis. This was a prospective observational study in a pediatric emergency department assessing children’s degree of dehydration as percentage of difference in convalescent weight compared to ill weight. 5% difference or greater was judged to be significant dehydration and correlated with IVC/Aorta ratios of 0.8 or less with a sensitivity of 86% and specificity of 56%.
- Chen L, Hsiao A, Langhan M, Riera A, Santucci KA. Use of bedside ultrasound to assess degree of dehydration in children with gastroenteritis. Acad Emerg Med. 2010 Oct;17(10):1042-7. doi: 10.1111/j.1553-2712.2010.00873.x. PMID: 21040104; PMCID: PMC3058669.
PYLORIC STENOSIS
INTUSSUSCEPTION
- Systematic review that identifies ultrasonographic features differentiating ileocolic intussusception (ICI) from small bowel-small bowel intussusception (SB-SBI). Key differentiators: ICI >2.5cm, SB-SBI <2.5cm; ICI typically seen in the right abdomen; SB-SBI typically seen in the left abdomen or periumbilical. Great review of technique and image-rich!
- Subramaniam S, Chen AE, Khwaja A, Rempell R. Point-of-Care Ultrasound For Differentiating Ileocolic From Small Bowel-Small Bowel Intussusception. J Emerg Med. 2022 Jan;62(1):72-82. doi: 10.1016/j.jemermed.2021.07.002. Epub 2021 Sep 11. PMID: 34521545.
- Prospective observational study of performance of point-of-care ultrasound used by six pediatric emergency physicians with no prior bowel ultrasound experience. After one hour of training, they scanned 82 pediatric patients with suspected intussusception and performed with a sensitivity of 85%, specificity of 97%, positive likelihood ratio 29 and negative likelihood ration 0.16 (compared with diagnostic radiology result).
- Riera A, Hsiao AL, Langhan ML, Goodman TR, Chen L. Diagnosis of intussusception by physician novice sonographers in the emergency department. Ann Emerg Med. 2012 Sep;60(3):264-8. doi: 10.1016/j.annemergmed.2012.02.007. Epub 2012 Mar 15. PMID: 22424652; PMCID: PMC3431911.
APPENDICITIS
- Retrospective chart review of 695 visits over 23 months. Patients who received PoCUS (n=209) had a shorter length of stay compared to patients who did not receive PoCUS (274 minutes vs 317 minutes, p<0.001).
- E Kasmire K, Davis J. Emergency Department Point-of-Care Ultrasonography Can Reduce Length of Stay in Pediatric Appendicitis: A Retrospective Review. J Ultrasound Med. 2021 Dec;40(12):2745-2750. doi: 10.1002/jum.15675. Epub 2021 Mar 4. PMID: 33665873.
- Point-of-care ultrasonography performs particularly well for patients with lower pretest probabilities, for whom a positive point-of-care ultrasonographic result greatly increases the probability of acute appendicitis. This systemic review found that point-of-care ultrasound for appendicitis had a positive likelihood ratio of 9.24 and negative likelihood ratio of 0.17.
- Favot MJ, Ehrman RR. What Elements of the History, Examination, Laboratory Testing, or Point-of-Care Ultrasonography Are Most Useful in the Diagnosis of Acute Appendicitis in Children? Ann Emerg Med. 2017 Dec;70(6):797-798. doi: 10.1016/j.annemergmed.2017.05.011. Epub 2017 Jun 26. PMID: 28662913.
- Pediatric emergency physicians that received didactics and hands-on training with a structure scanning algorithm, including graded compression technique, for evaluation of appendicitis were able to accurately diagnosis acute appendicitis. A prospective study at an urban pediatric emergency department found that bedside ultrasound had a sensitivity of 85%, specificity of 93%, positive likelihood ration of 11.7 and negative likelihood ratio of 0.17.
- Sivitz AB, Cohen SG, Tejani C. Evaluation of acute appendicitis by pediatric emergency physician sonography. Ann Emerg Med. 2014 Oct;64(4):358-364.e4. doi: 10.1016/j.annemergmed.2014.03.028. Epub 2014 May 29. PMID: 24882665.
PROCEDURES
MUSCULOSKELETAL