Point of care ultrasound in haemophilia: Building a strong foundation for clinical implementation

Lawson, W; Uy, Michael; Strike, Karen; Iorio, Alfonso; Stein, Nina Rodrigues; Koziol, L; Chan, Anthony

doi:10.1111/hae.13269

Cited by 14 publications

(23 citation statements)

References 13 publications

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“…This observation emphasizes the fact that experience and hands‐on practice are required beyond didactic instruction to optimize the accuracy of the readings and the interpretation of musculoskeletal US images. This and other observations support the belief that point‐of‐care (musculoskeletal) US imaging can be learned and correctly applied by nonradiologists but requires appropriate education, continued practice, and accumulation of experience to ensure accurate clinical assessments …”

Section: Discussionsupporting

confidence: 65%

Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints

Volland

Zhou

Barnes

et al. 2018

J of Ultrasound Medicine

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Objectives Musculoskeletal ultrasound (US) is used increasingly to examine hemophilic arthropathy. However, quantitative algorithms to document findings are lacking. We developed and sought to validate a protocol quantifying hemophilic joint abnormalities. Methods Thirty‐one patients with hemophilia were examined serially for 2 years with musculoskeletal US (≈600 joint examinations and ≈6000 images). Based on the spectrum of pathologies, a quantitative algorithm, named Joint Tissue Activity and Damage Examination (JADE), was developed for soft tissue and osteochondral measurements, including power Doppler, using nominal group techniques. To study intra‐ and inter‐rater reliability, 8 musculoskeletal US–experienced hemophilia providers performed anatomic landmark recognition and tissue measurements on 86 images with arthropathic changes, with repetition 1 month later. Twenty‐three musculoskeletal US–inexperienced providers performed similar assessments. Inter‐operator reliability was established by 6 musculoskeletal US–experienced hemophilia providers, each acquiring images and JADE assessments of 3 hemophilic arthropathic joints. A radiologist and musculoskeletal sonographer functioned as adjudicators. The statistical analysis was performed with the intraclass correlation coefficient (ICC), Fleiss κ, and Cohen κ where appropriate. Results The musculoskeletal US–experienced providers showed excellent intra‐and inter‐rater reliability for tissue measurements (ICCs, 0.94–0.96). Agreement was good to excellent for landmark recognition (Fleiss κ, 0.87‐0.94). Inter‐operator reliability was excellent for measurements and landmark recognition (ICC, 0.90; Fleiss κ, 1.0). Agreement with adjudicators was mostly good to excellent. Musculoskeletal US–inexperienced providers showed excellent inter‐rater reliability for measurements (ICC, 0.96) and moderate agreement for landmark recognition (Fleiss κ, 0.58). Conclusions The JADE protocol appears feasible for quantifying hemophilic intra‐articular abnormalities. Musculoskeletal US–trained hemophilia providers showed high intra‐rater, inter‐rater, and inter‐operator reliability, supporting JADE as a protocol for clinical management and research.

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Section: Discussionsupporting

confidence: 65%

Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints

Volland

Zhou

Barnes

et al. 2018

J of Ultrasound Medicine

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“…Operators should have received proper training before implementation of POC‐US in haemophilia care in order to avoid incorrect diagnosis and misuse. Recommendations and guidelines on training standards, appropriate use and quality assurance have therefore been described …”

Section: Discussionmentioning

confidence: 99%

Diagnostic accuracy of point‐of‐care ultrasound for evaluation of early blood‐induced joint changes: Comparison with MRI

et al. 2018

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Introduction Recurrent joint bleeding is the hallmark of haemophilia. Synovial hypertrophy observed with Magnetic Resonance Imaging (MRI) is associated with an increased risk of future joint bleeding. Aim The aim of this study was to investigate whether point‐of‐care ultrasound (POC‐US) is an accurate alternative for MRI for the detection of early joint changes. Methods In this single centre diagnostic accuracy study, bilateral knees and ankles of haemophilia patients with no or minimal arthropathy on X‐rays were scanned using POC‐US and 3 Tesla MRI. POC‐US was performed by 1 medical doctor, blinded for MRI, according to the “Haemophilia Early Arthropathy Detection with Ultrasound” (HEAD‐US) protocol. MRIs were independently scored by 2 radiologists, blinded for clinical data and ultrasound results. Diagnostic accuracy parameters were calculated with 95% confidence intervals (CI). Results Knees and ankles of 24 haemophilia patients (96 joints), aged 18‐34, were studied. Synovial hypertrophy on MRI was observed in 20% of joints. POC‐US for synovial tissue was correct (overall accuracy) in 97% (CI: 91‐99) with a positive predictive value of 94% (CI: 73‐100) and a negative predictive value of 97% (CI: 91‐100). The overall accuracy of POC‐US for cartilage abnormalities was 91% (CI: 83‐96) and for bone surface irregularities 97% (CI: 91‐99). Conclusion POC‐US could accurately assess synovial hypertrophy, bone surface irregularities and cartilage abnormalities in haemophilia patients with limited joint disease. As POC‐US is an accurate and available alternative for MRI, it can be used for routine evaluation of early joint changes.

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“…The reason for the difference in discordance is not clear from the studies. Nevertheless, discordance between clinical and ultrasound examinations suggests concurrent physical and US examinations may supplement each other when monitoring joint health of people with haemophilia at the point‐of‐care …”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, discordance between clinical and ultrasound examinations suggests concurrent physical and US examinations may supplement each other when monitoring joint health of people with haemophilia at the point-of-care. 6,8,17 Ultrasound imaging is highly operator-dependent and one of the limitations of its use at the point-of-care is interoperator variability. Whilst the HEAD-US protocol has been shown to be repeatable when undertaken by radiologists, 16 with inter-rater kappa values of 0.69-0.80 (95% CI 0.46-0.93) there is limited reliability data for non-radiologists for which its use has been indicated.…”

mentioning

confidence: 99%

Physiotherapist inter‐rater reliability of the Haemophilia Early Arthropathy Detection with Ultrasound protocol

et al. 2018

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Point of care ultrasound in haemophilia: Building a strong foundation for clinical implementation

Cited by 14 publications

References 13 publications

Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints

Development and Reliability of the Joint Tissue Activity and Damage Examination for Quantitation of Structural Abnormalities by Musculoskeletal Ultrasound in Hemophilic Joints

Diagnostic accuracy of point‐of‐care ultrasound for evaluation of early blood‐induced joint changes: Comparison with MRI

Physiotherapist inter‐rater reliability of the Haemophilia Early Arthropathy Detection with Ultrasound protocol

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