Reliability of Neck Mass Point‐of‐Care Ultrasound by Pediatric Emergency Physicians

Friedman, Nir; Tseng, Felicia; Savic, Ranko; Diallo, Mamadou Alpha; Fathi, K; McLean, Les; Tessaro, Mark O.

doi:10.1002/jum.14993

Cited by 11 publications

(8 citation statements)

References 27 publications

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“…Interestingly, pediatricians ranked neck (lymph node vs abscess), advanced abdominal (appendicitis, intussusception, hypertrophic pyloric stenosis, cholecystitis) among the most useful diagnostic applications, studies which tend to be considered more advanced by POCUS experts [ 12 , 16 ]. While the POCUS literature for pediatric appendicitis [ 2 , 38 ] and intussusception [ 39 , 40 ] is growing, there is currently limited evidence to support the use of POCUS for differentiation of neck masses [ 41 – 43 ]. Constipation was also ranked as a useful diagnostic application by pediatricians; however, there are currently only a handful of studies on the validity of measuring transrectal diameter in the diagnosis of pediatric constipation [ 44 – 46 ].…”

Section: Discussionmentioning

confidence: 99%

The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey

et al. 2022

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Background Point-of-care ultrasound (POCUS) is a noninvasive bedside tool with many pediatric applications but is not currently a formal part of pediatric training and practice. Formal surveys of general pediatricians regarding POCUS training are lacking. We aimed to quantify the baseline ultrasound experience and training needs of general pediatricians and pediatric residents across different practice settings. Methods In 2020, we sent an online survey to 485 current faculty, residents, and graduates from an urban pediatric academic medical center in Northern California. Pediatric subspecialists were excluded. Survey questions about baseline experience, comfort, and perceived usefulness of 20 common POCUS applications were developed by two POCUS experts using existing literature. Chi-squared analysis was used to compare residents versus attendings and to compare attendings practicing in inpatient versus outpatient versus mixed settings. Results Response rate was 20% (98/485). Compared to attendings (n = 73), residents (n = 25) endorsed more exposure to POCUS in medical school (32% vs 5%, p = 0.003) and residency (12% vs 5%, p = 0.003). Respondents endorsed low comfort with POCUS (mean 1.3 out of 5 on Likert scale). Of 20 procedural and diagnostic applications, respondents identified abscess drainage, bladder catheterization, soft tissue, neck, advanced abdominal, and constipation as most useful. Overall, 50% of pediatricians (and 70% of pediatric residents) responded that there were opportunities to use POCUS multiple times a week or more in their clinical practice. Conclusions There is an unmet demand for POCUS training among general pediatricians and trainees in our study. Although the majority of respondents were not POCUS users, our results could guide future efforts to study the role of POCUS in general pediatrics and develop pediatric curricula.

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Section: Discussionmentioning

confidence: 99%

The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey

et al. 2022

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“…Two studies ( n = 27 and n = 75) evaluated EP PoCUS diagnostic accuracy on paediatric soft-tissue neck masses and found a Cohen’s kappa coefficient when compared to the final diagnosis of 0.69 (95% CI 0.44–0.94) and 0.71 (0.60–0.83), respectively [184, 185].…”

Section: Resultsmentioning

confidence: 99%

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

Sorensen¹,

Hunskaar

2019

Ultrasound J

109

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Background: Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services.Methods: Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. Results:On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/ thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. Conclusion:Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients. which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

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“…POCUS is being increasingly utilised as part of the evaluation for the infant, child or young person presenting to the PED with an undifferentiated neck mass, as both a tool for aiding decision making and for streamlining patient flow. Studies have demonstrated the benefits it provides in terms of both diagnostic accuracy and an overall shorter length of stay in the PED [11][12][13][14][15].…”

Section: Discussionmentioning

confidence: 99%

A Rare Cause of Neck Lump in an Infant

McCreary

Lashhab²

2022

pocus

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A 5 month old girl presented to the Paediatric Emergency Department with a rapidly growing neck mass over 24 hours. She was systemically well and otherwise asymptomatic. On examination she had a mobile, soft and non-tender 5 cm x 5 cm neck mass. Blood tests were unremarkable with normal inflammatory markers. Point of Care Ultrasound (POCUS) was done which showed a solid left sided neck mass with increased vascularity but no evidence of collection or abscess. Given the atypical presentation and rapid growth the patient was commenced on empirical antibiotics and was discussed with both tertiary ENT and Oncology teams. An MRI was performed which was indeterminate. Biopsy of the neck mass was positive for Ewing Sarcoma. This is a rare case of Ewing Sarcoma in an infant. POCUS can be used to rule out common pathology and abnormal lymph nodes, aiding in ongoing investigation and management in neck lumps.

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Reliability of Neck Mass Point‐of‐Care Ultrasound by Pediatric Emergency Physicians

Cited by 11 publications

References 27 publications

The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey

The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey

Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations

A Rare Cause of Neck Lump in an Infant

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