Objective To investigate the performance characteristics of bedside emergency department ultrasound by non-radiologist, physician sonographers in the diagnosis of ileo-colic intussusception in children. Methods This was a prospective, observational study conducted in a pediatric emergency department of an urban tertiary care children’s hospital. Pediatric emergency medicine (PEM) physicians with no previous experience in bowel ultrasound underwent a focused one-hour training session conducted by a pediatric radiologist. The session included a didactic component on sonographic appearances of ileo-colic intussusception, review of positive and negative images for intussusceptions, and a hands-on component using a live child model. Upon completion of the training a prospective convenience sample study was performed. Children were enrolled if they were to undergo a diagnostic radiology (DR) ultrasound for suspected intussusception. Bedside ultrasound (BUS) by trained PEM physicians were performed and interpreted as either positive or negative for ileo-colic intussusception. Ultrasound studies were then performed by DR and their results were used as the reference standard. Test characteristics (sensitivity, specificity, positive and negative predictive values) and likelihood ratios were calculated. Results Six PEM physicians completed the training and performed the bedside studies. Eighty two patients were enrolled. The median age was 25 months (range 3 months – 127 months). Thirteen patients (16%) were diagnosed with ileo-colic intussusception by DR. BUS had a sensitivity of 85% (95% confidence interval [CI] 54% to 97%), specificity of 97% (95% CI 89% to 99%), positive predictive value of 85% (95% CI 54% to 97%) and negative predictive value of 97% (95% CI 89% to 99%). A positive BUS had a likelihood ratio of 29 (95% CI 7.3 to 114) and a negative BUS had a likelihood ratio of 0.16 (95% CI 0.04 to 0.57). Conclusions With limited and focused training, PEM physicians can accurately diagnose ileo-colic intussusception in children using BUS.

Objective To determined the current incidence and acute complications of asymptomatic central venous catheter (CVC)-related deep venous thrombosis (DVT) in critically ill children. Study design We performed a prospective cohort study in 3 pediatric intensive care units. A total of 101 children with newly inserted untunneled CVC were included. CVC-related DVT was diagnosed using compression ultrasonography with color Doppler. Results Asymptomatic CVC-related DVT was diagnosed in 16 (15.8%) children, which equated to 24.7 cases per 1000 CVC-days. Age was independently associated with DVT. Compared with children aged <1 year, children aged >13 years had significantly higher odds of DVT (aOR, 14.1, 95% CI, 1.9–105.8; P = .01). Other patient demographics, interventions (including anticoagulant use), and CVC characteristics did not differ between children with and without DVT. Mortality-adjusted duration of mechanical ventilation, a surrogate for pulmonary embolism, was statistically similar in the 2 groups (22 ± 9 days in children with DVT vs 23 ± 7 days in children without DVT; P = .34). Mortality-adjusted intensive care unit and hospital lengths of stay also were similar in the 2 groups. Conclusion Asymptomatic CVC-related DVT is common in critically ill children. However, the acute complications do not seem to differ between children with and without DVT. Larger studies are needed to confirm these results. Future studies should also investigate the chronic complications of asymptomatic CVC-related DVT.

Three-dimensional (3D) printing has recently erupted into the medical arena due to decreased costs and increased availability of printers and software tools. Due to lack of detailed information in the medical literature on the methods for 3D printing, we have reviewed the medical and engineering literature on the various methods for 3D printing and compiled them into a practical "how to" format, thereby enabling the novice to start 3D printing with very limited funds. We describe (1) background knowledge, (2) imaging parameters, (3) software, (4) hardware, (5) post-processing, and (6) financial aspects required to cost-effectively reproduce a patient's disease ex vivo so that the patient, engineer and surgeon may hold the anatomy and associated pathology in their hands.

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