Pediatric Ultrasound

Leeson, Kimberly; Leeson, Ben

doi:10.1016/j.emc.2013.05.005

Cited by 26 publications

(9 citation statements)

References 113 publications

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“…However, the study has the merit of investigating a novel approach. When compared to other existing studies in the paediatric field [ 3 , 10 , 33 – 38 ], our study represents a novelty, since no study so far has reported the use of tele-mentored POC US in the hands of paediatricians in the ED. Findings of this study suggest that tele-POC may be valuable for increasing the number of conditions evaluated by paediatricians with POC US in the ED.…”

Section: Discussionmentioning

confidence: 93%

“…Despite this is a very rapidly evolving field of medicine, so far only a few studies have evaluated other paediatric applications of POC US when in the hands of paediatricians. Overall, while the prospect of improving timely diagnoses is appealing, accuracy in the diagnosis and the final real benefits of POC US for children are still under evaluation [ 1 – 3 , 10 ]. Resistance to the use of POC US in the hands of “non radiologist” includes the fact that usually it addresses “yes” or “no” questions (e.g.…”

Section: Introductionmentioning

confidence: 99%

“…presence or absence of fluid in the peritoneal cavity) and it can neither be compared with, nor substitute, a comprehensive evaluation conducted by a specialist radiologist [ 3 , 6 ]. Currently it is still unclear how many children, after a POC US performed by a non-radiologist, need to be evaluated by a radiologist as well [ 1 – 3 , 5 , 10 ]. Given all of the above considerations, the real benefit of POC US for children, their families, and for the health system is still unclear.…”

Section: Introductionmentioning

confidence: 99%

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Real-Time Tele-Mentored Low Cost “Point-of-Care US” in the Hands of Paediatricians in the Emergency Department: Diagnostic Accuracy Compared to Expert Radiologists

et al. 2016

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BackgroundThe use of point-of-care ultrasonography (POC US) in paediatrics is increasing. This study investigated the diagnostic accuracy of POC US in children accessing the emergency department (ED) when performed by paediatricians under the remote guidance of radiologists (TELE POC).MethodsChildren aged 0 to 18 years accessing the ED of a third level research hospital with eight possible clinical scenarios and without emergency/severity signs at the triage underwent three subsequent US tests: by a paediatrician guided remotely by a radiologist (TELE POC); by the same radiologist (UNBLIND RAD); by an independent blinded radiologist (BLIND RAD). Tele-radiology was implemented using low cost “commercial off-the-shelf” (COTS) equipment and open-source software. Data were prospectively collected on predefined templates.ResultsFifty-two children were enrolled, for a total of 170 ultrasound findings. Sensitivity, specificity, positive and negative predictive values of TELE POC were: 93.8, 99.7, 96.8, 99.4 when compared to UNBLIND RAD and 88.2, 99.7, 96.8, 98.7 when compared to BLIND RAD. The inter-observers agreement between the paediatricians and either the unblind or blind radiologist was excellent (k = 0.93). The mean duration of TELE POC was 6.3 minutes (95% CI 4.1 to 8.5). Technical difficulties occurred in two (3.8%) cases. Quality of the transmission was rated as fair, good, very good and excellent in 7.7%, 15.4%, 42.3% and 34.6% of cases respectively, while in no case was it rated as poor.ConclusionsPOC US performed by paediatricians in ED guided via tele-radiology by an expert radiologist (TELE POC) produced reliable and timely diagnoses. Findings of this study, especially for the rarer conditions under evaluation, need further confirmation. Future research should investigate the overall benefits and the cost savings of using tele-ultrasound to perform US “at children’s bedsides”, under remote guidance of expert radiologists.

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Section: Discussionmentioning

confidence: 93%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Real-Time Tele-Mentored Low Cost “Point-of-Care US” in the Hands of Paediatricians in the Emergency Department: Diagnostic Accuracy Compared to Expert Radiologists

et al. 2016

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“…The detection of pericardial effusion and tamponade, the evaluation of the global contractility, the assessment of left ventricular function and right ventricular filling, the assessment of Pulseless Electrical Activity and asystole [ 7 – 11 ] are the most common indications for POCE. Longjohn et al demonstrated in a prospective observational study that pediatric emergency physicians could be able to perform POCE as effectively as a pediatric cardiologist in the PED, with an accurate assessment of left ventricle (LV) systolic dysfunction, cardiac preload, and presence or absence of pericardial effusion [ 12 ].…”

Section: Resultsmentioning

confidence: 99%

Point of care ultrasonography in the pediatric emergency department

et al. 2018

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ImportancePoint-of-care ultrasonography (POCUS) allows to obtain real-time images to correlate with the patient’s presenting signs and symptoms. It can be used by various specialties and may be broadly divided into diagnostic and procedural applications.ObjectiveWe aimed at reviewing current knowledge on the use of POCUS in Pediatric Emergency Departments (PEDs).FindingsUS diagnostic capacity in paediatric patients with suspected pneumonia has been studied and debated whereas literature regarding the usefulness of point-of-care echocardiography in the pediatric setting is still limited. Similarly, Focused Assessment with Sonography for Trauma (FAST) has become a standard procedure in adult emergency medicine but it is still not well codified in the pediatric practice. Concerning procedural applications of POCUS we identified 4 main groups: peripheral vascular access, bladder catheterizations, identification and drainage of abnormal fluid collections and foreign body identification.Conclusions and relevanceBedside emergency ultrasound is routinely used by adult emergency physicians and in the last 10 years its application is recognized and applied in PED. Pediatric emergency physicians are encouraged to familiarize with POCUS as it is a safe technology and can be extremely helpful in performing diagnosis, managing critical situations and guiding procedures, which results in globally improving pediatric patients care.

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“…Although CT is more accurate than US, US has many advantages for diagnosis in the PED [ 23 , 24 ]. One advantage is the lack of radiation exposure.…”

Section: Discussionmentioning

confidence: 99%

Long-term changes in computed tomography and ultrasound utilization in a pediatric emergency department

et al. 2018

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ObjectiveMany studies have proposed reducing unnecessary use of computed tomography (CT), and ongoing studies in pediatric populations are aiming to decrease radiation dosages whenever possible. We aimed to evaluate the long-term changes in the utilization patterns of CT and ultrasound (US) in pediatric emergency departments (PEDs).MethodsThis retrospective study reviewed the electronic medical data of patients who underwent CT and/or US in the PED of a tertiary referral hospital from 2000 to 2014. We compared the changes in utilization patterns of brain and abdominal CT scans in pediatric patients and analyzed changes in abdominal US utilization in the PED.ResultsDuring the study period, 196,371 patients visited the PED. A total of 12,996 brain and abdominal CT scans and 12,424 abdominal US were performed in the PED. Comparison of CT use in pediatric patients before and after 2007 showed statistically decreasing trends after 2007, expressed as the coefficient values of the differences in groups. The numbers of brain and abdominal CT scans showed a significant decreasing trend in children, except for abdominal CT in adolescents. The abdominal US/CT ratio in the PED showed a statistically significant increase (2.68; 95% confidence interval, 1.87 to 3.49) except for the adolescent group (5.82; 95% confidence interval, -2.06 to 13.69).ConclusionOverall, CT use in pediatric patients has decreased since 2007. Pediatric US use has also shown a decreasing trend; however, the abdominal US/CT ratio in pediatric patients showed an increasing trend, except for adolescents.

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Pediatric Ultrasound

Cited by 26 publications

References 113 publications

Real-Time Tele-Mentored Low Cost “Point-of-Care US” in the Hands of Paediatricians in the Emergency Department: Diagnostic Accuracy Compared to Expert Radiologists

Real-Time Tele-Mentored Low Cost “Point-of-Care US” in the Hands of Paediatricians in the Emergency Department: Diagnostic Accuracy Compared to Expert Radiologists

Point of care ultrasonography in the pediatric emergency department

Long-term changes in computed tomography and ultrasound utilization in a pediatric emergency department

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