Feasibility of Point-of-Care Ultrasound for Diagnosing Hypertrophic Pyloric Stenosis in the Emergency Department

Abstract

Objectives: This study aimed to investigate the feasibility of point-ofcare ultrasound (POCUS) for diagnosing hypertrophic pyloric stenosis (HPS) in the emergency department (ED).Methods: A retrospective study was conducted in infants aged younger than 90 days who were brought to the ED due to vomiting between January 2015 and December 2019. Of these, infants who were clinically suspected of having HPS and underwent ultrasound were included and categorized into 3 groups: POCUS only, POCUS followed by radiologist-performed ultrasound (RADUS), and RADUS only. All confirmative diagnoses of HPS were made by RADUS. The diagnostic performance of POCUS was analyzed, and the ED patient flow was compared between the POCUS-performed (POCUS only or POCUS followed by RADUS) and RADUS-only groups.Results: Overall, 171 patients with a median age of 34 days were included. Of these, 79 patients (46.2%) underwent POCUS only, and none had HPS; 50 patients (29.2%) underwent POCUS followed by RADUS; and 42 patients (24.5%) underwent RADUS only. Overall, 41 patients (24.0%) were diagnosed with HPS, and POCUS showed a sensitivity of 96.6% and specificity of 94.0%. In the total cohort, length of stay in the ED (EDLOS) was shorter in the POCUS-performed group than in the RADUS-only group (2.6 vs 3.8 hours, P = 0.015). Among non-HPS patients, time to disposition (1.8 vs 2.7 hours, P = 0.005) and EDLOS (2.0 vs 3.0 hours, P = 0.004) were shorter in the POCUS-performed group than in the RADUS-only group. Performing POCUS followed by RADUS did not significantly delay the treatment among HPS patients.Conclusions: Point-of-care ultrasound is accurate and useful for diagnosing HPS and improved the ED patient flow by reducing EDLOS and door-to-disposition time in non-HPS patients.

Gastric Point-of-Care Ultrasound in Acutely and Critically Ill Children (POCUS-ped): A Scoping Review

“…Most studies were recent (published in the last 10 years) as the availability of portable ultrasound machines was not common before the 2010's, when radiologists used to be responsible for ultrasounding patients. POCUS has been shown to decrease the time to diagnosis and treatment ( 12 ). Overall, the gastric POCUS learning curve is short, and several studies showed good reliability of measurements and interpretations ( 7 – 9 , 12 , 52 , 64 , 69 , 70 , 72 ).…”

“…Totally, eight studies were identified ( Table 4 ) ( 5 , 12 , 67 , 69 – 72 , 80 ), and 652 infants younger than 6 months presenting with signs of HPS were recruited in the ED; three studies examined gastric POCUS performed by surgeons ( 5 , 67 , 69 ) and five by ED physicians ( 12 , 70 – 72 , 80 ). In these studies, POCUS was compared to RADUS; in four other studies, the learning curve and training were assessed (surgeons training surgeons, surgeons training ED physicians, or ED physicians training ED physicians) ( 69 , 71 , 72 ).…”

“…Figure 6 presents an example of HPS and details the gastric POCUS technique. Regarding the accuracy of POCUS compared to RADUS, sensitivity and specificity ranged from 96.6 to 100% and from 94 to 100%, respectively ( 12 , 70 ). The measurements of the pylorus muscle obtained by radiologists or surgeons/ED physicians did not significantly differ.…”

“…The measurements of the pylorus muscle obtained by radiologists or surgeons/ED physicians did not significantly differ. One study assessed the impact of POCUS on the length of ED stays and found that POCUS significantly shortened ED stay in children with HPS and time to disposition in children with no HPS ( 12 ). The ability of healthcare professionals trained in POCUS to train their ED colleagues was good, with no false positives or false negatives in two studies ( 69 , 72 ), and as shown the third study, pre-/post-training test scores improved from a mean of 61–83% correct, respectively ( 71 ).…”

“…The pediatric literature reports some data on the use of gastric POCUS in five main domains: (i) assessing gastric emptying and gastric volume/contents, (ii) gastric foreign body identification, (iii) confirming nasogastric (or orogastric) tube (NGT) position, (iv) hypertrophic pyloric stenosis (HPS) diagnosis, and (v) other indications (e.g., assessment of ventilation on gastric insufflation) ( 2 , 4 – 12 ).…”