The Utility of Bedside Ultrasound and Patient Perception in Detecting Soft Tissue Foreign Bodies in Children

Friedman, David I.; Forti, Rene J.; Wall, Stephen P.; Crain, Ellen F.

doi:10.1097/01.pec.0000173344.30401.8e

Cited by 53 publications

(27 citation statements)

References 23 publications

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“…The reported rate of traumatic or failed LPs in children is between 10 and 50%, depending on patient age and the red blood cell (RBC) count used to define "traumatic." [1][2][3][4][5][6][7] Bedside point-of-care ultrasound is used by emergency physicians to facilitate the performance of a variety of procedures, including the presence and need for reduction of long-bone fractures, 7 detection of foreign bodies, 8 successful collection of urine specimens, 9 and central line placement. 10 A prospective randomized controlled trial in adults documented the beneficial effect of ultrasound-assisted lumbar puncture (UALP).…”

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confidence: 99%

Prospective Investigation of a Novel Ultrasound‐assisted Lumbar Puncture Technique on Infants in the Pediatric Emergency Department

Gorn

Kunkov

Crain

2017

Academic Emergency Medicine

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Objective: The objective was to describe a novel ultrasound-assisted lumbar puncture (UALP) technique and to compare it to standard lumbar puncture (SLP) technique in infants.Methods: A prospective, randomized, controlled study in infants 60 days old and younger undergoing a lumbar puncture (LP) in a pediatric emergency department. Patients with a spinal anomaly or ventriculoperitoneal shunt were excluded. Eligible infants were randomized to UALP or SLP. A spinal sonogram was performed on all patients by an investigator not involved in performing the LP. Spinal landmarks and maximum safe depth were identified for the UALP providers. Providers in the SLP group were blinded to sonographic measurements. A successful LP was defined as the collection of cerebrospinal fluid (CSF) with a red blood cell count of less than 10,000 cells/mm 3 . Statistical analysis included chi-square, Mann-Whitney U-test, and number needed to treat (NNT).Results: Forty-three patients were enrolled, 21 in the UALP group and 22 in the SLP group. Prematurity, weight, length, provider experience, anesthesia use, stylet technique, and number of attempts were similar between groups. The median age in the UALP group was 38 days (interquartile range [IQR] = 33 days) versus 45 days (IQR = 19 days) in the SLP group (p = 0.02). CSF was obtained in all UALP subjects (100%) versus in 18 of 22 (82%) in the SLP group (p = 0.04); 20 (95%) UALP subjects versus 15 (68%) SLP subjects met our definition of success (p = 0.023). The odds ratio of successful LP using UALP technique was 9.33 (95% confidence interval [CI] = 1.034 to 84.026) and the NNT was 3.7 (95% CI = 2.02 to 24.18). Conclusion:The UALP technique increases the rate of a successful LP in infants compared to standard technique.

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Prospective Investigation of a Novel Ultrasound‐assisted Lumbar Puncture Technique on Infants in the Pediatric Emergency Department

Gorn

Kunkov

Crain

2017

Academic Emergency Medicine

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“…30 This study reported a sensitivity of 66.7% (95% CI = 34.8% to 90.1%) and a specificity of 96.6% (95% CI = 91.6% to 99.1%). Four studies 24,28,31,33 took place in the general ED setting, one in a pediatric ED, 30 and two in orthopedic EDs. 25,26 Our meta-analysis yielded overall sensitivity and specificity of 72% (95% CI = 57% to 83%) and 92% (95% CI = 88% to 95%), respectively ( Figure 2).…”

Section: Resultsmentioning

confidence: 78%

“…After our complete review of these articles and their reference sections and our limited reviews of other databases, we included 17 articles in this metaanalysis (Table 1). All 17 studies [23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39] reported data for calculation of sensitivity; however, only 13 [23][24][25][26][27][28][29][30][31][32][33][34]36,37 reported data for calculation of specificity.…”

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confidence: 99%

“…The one study in the current meta-analysis that examined point-of-care US was a large study of 131 foreign bodies in 105 pediatric patients, and it reported a sensitivity of 67% and specificity of 96.6%. 30 There are little data on the amount of training and point-of-care US experience required to accurately identify soft tissue foreign bodies. In another study by Orlinsky et al, 42 point-of-care sonographers achieved similar accuracy to radiologists and US technicians after a 2-day course in point-of-care US and a focused didactic session on foreign bodies.…”

Section: Discussionmentioning

confidence: 99%

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Diagnostic Accuracy of Ultrasonography in Retained Soft Tissue Foreign Bodies: A Systematic Review and Meta-analysis

Davis

Czerniski

et al. 2015

Acad Emerg Med

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Objectives: Open wounds with the potential for retained foreign bodies are frequently seen in the emergency department (ED). Common foreign bodies, such as wood or glass, are often missed on physical examination and conventional radiography. The increased use of ultrasonography (US) in the ED presents an opportunity to better identify retained soft tissue foreign bodies, and understanding of its test characteristics is desirable. The authors set out to determine the test characteristics of US for detection of soft tissue foreign bodies by performing a systematic review and meta-analysis of the existing literature.Methods: This was a thorough, systematic review of OVID Medline, SCOPUS, and Cochrane databases and a limited review of Directory of Open Access Journals, Google Scholar, and ClinicalTrials.gov to identify clinical studies examining the diagnostic accuracy of US in the identification of retained soft tissue foreign bodies. Studies were selected for full-text review by two independent reviewers to determine if they met inclusion criteria. Results were pooled for test characteristics using STATA and assessed for risk of bias and applicability using the QUADAS-2 tool.Results: This systematic search strategy identified 5,059 unique articles, and 17 articles met inclusion criteria. Pooled sensitivity and specificity were, respectively, 72% (95% confidence interval [CI] = 57% to 83%) and 92% (95% CI = 88% to 95%). Overall quality of the studies was low and interstudy heterogeneity was high (I 2 = 90%, 95% CI = 80% to 100%).Conclusions: Ultrasonography is highly specific and moderately sensitive in the identification of retained soft tissue foreign bodies; however, studies to date have a high degree of heterogeneity and a high risk of bias.ACADEMIC EMERGENCY MEDICINE 2015;22:777-787

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“…[19][20][21][22][23][24] Therefore, it is important that pediatric EPs be appropriately trained in its use. Ours is the first study to evaluate emergency EUS training for pediatric EPs.…”

Section: Discussionmentioning

confidence: 99%

Assessment of a Training Curriculum for Emergency Ultrasound for Pediatric Soft Tissue Infections

Marin

Panebianco

Dean

2011

Academic Emergency Medicine

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Objectives: The objective was to evaluate a training protocol for pediatric emergency physicians (EPs) learning emergency ultrasound (EUS) for the evaluation of skin and soft tissue infections (SSTIs) by assessing technical ability and interrater reliability.Methods: Pediatric emergency medicine (EM) fellows and attending physicians completed a 1-day training course taught by an expert emergency sonologist. After the course, EPs performed proctored examinations on patients with SSTIs until they reached predefined performance criteria, after which they performed independent EUS examinations. All EUS examinations were recorded using still images and video clips that were reviewed and rated by the expert sonologist on four technical measures and combined into a composite score. The expert's opinion regarding the presence or absence of an abscess was also compared to the study sonologist's opinion and analyzed for interrater reliability.Results: Seven EPs performed 107 EUS examinations. The mean (±SD) composite score for the evaluation of technical ability for the first EUS was 3.3 ± 0.14 (on a 4-point scale), indicating a high level of quality following the training course. There was a small amount of improvement in the quality score (0.015, 95% confidence interval [CI] = 0.0003 to 0.03) with each consecutive EUS examination. The interrater reliability between the sonologist and the expert for the presence of an abscess as measured by the kappa statistic was 0.80 (95% CI = 0.63 to 0.97), indicating substantial agreement.

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The Utility of Bedside Ultrasound and Patient Perception in Detecting Soft Tissue Foreign Bodies in Children

Abstract: Bedside US is comparable to the performance of radiography interpreted by an attending pediatric radiologist. Bedside US alone or combined with patient perception may be an adequate initial screening tool for detecting wound FBs.

Cited by 53 publications

References 23 publications

Prospective Investigation of a Novel Ultrasound‐assisted Lumbar Puncture Technique on Infants in the Pediatric Emergency Department

Prospective Investigation of a Novel Ultrasound‐assisted Lumbar Puncture Technique on Infants in the Pediatric Emergency Department

Diagnostic Accuracy of Ultrasonography in Retained Soft Tissue Foreign Bodies: A Systematic Review and Meta-analysis

Assessment of a Training Curriculum for Emergency Ultrasound for Pediatric Soft Tissue Infections

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