Ovarian Torsion
Conditions
Keywords
Pediatric, Point-of-care Ultrasound, Bladder volume
Brief summary
The purpose of this study is to investigate whether or not furosemide causes the bladder to fill faster than IV fluids alone so that a pelvic ultrasound exam can be performed.
Detailed description
Trans-abdominal pelvic ultrasound is the standard imaging modality for diagnosis of ovarian torsion in the pediatric population, however this requires that the patient have a full bladder at the time of imaging. This study will investigate whether low dose furosemide in addition to IV fluid boluses may provide a fast, effective, and non-invasive means to fill the bladder of pediatric females awaiting pelvic US. The target population are females age 8 to 18 years seen in the emergency room at Connecticut Children's Medical Center who are undergoing a trans-abdominal pelvic ultrasound to assess for ovarian torsion. Enrolled patients will be randomized to the control (IVF bolus only) group vs. the intervention (IVF bolus + furosemide) group and will undergo point-of-care US (POCUS) and bladder scanner evaluation of the bladder every 30 minutes until the bladder is determined to be full.
Interventions
DRUGFurosemide
0.1mg/kg (max 5mg) of IV furosemide
DRUGNormal saline
20mL/kg (max 1000mL) normal saline bolus plus a normal saline flush
Sponsors
Connecticut Children's Medical Center
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
DIAGNOSTIC
Masking
SINGLE (Subject)
Intervention model description
Randomized controlled trial
Eligibility
Sex/Gender
FEMALE
Age
8 Years to 18 Years
Healthy volunteers
Yes
Inclusion criteria
1. Females age 8-18yrs seen in the ED at CCMC who are undergoing a trans-abdominal pelvic ultrasound to assess for ovarian torsion 2. Ability of patient (if 18yrs) or parent/legal guardian to sign a written informed consent
Exclusion criteria
1. History of renal, genitourinary, or pelvic anomalies a. Eg: Chronic kidney disease, anuria, vesicoureteral reflux, ureteral obstruction, urologic reconstructive surgery, suprapubic or pelvic surgery, indwelling urethral catheter, oophorectomy, bicornate uterus 2. Patients with multiple chronic illnesses or systemic neurologic abnormality a. Eg: Bronchopulmonary dysplasia, tracheostomy, gastrostomy tube dependence, cerebral palsy, severe developmental delay, mitochondrial disorder, congenital heart disease, cardiomyopathy, chronic kidney disease, diabetes 3. Patients with known pregnancy 4. Patients deemed to be critically ill a. Mental status changes, signs of end organ damage, hypotension 5. Contraindication to giving Furosemide a. Allergy to sulfonamide medications, severe dehydration, hypotension, underlying electrolyte abnormality, underlying renal disease 6. History of previous diuretic use within the past year 7. Patients who self-report their bladder as being full at the time of enrollment
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The time from initiation of the intervention to the time that the bladder reaches large, ovoid shape on POCUS exam | Through study completion, about 3 hours | Initiation of the intervention is defined as administration of furosemide vs. normal saline flush. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The correlation between bladder volume as calculated on POCUS exam of a large, ovoid bladder and bladder volume as reported by bladder scanner | Through study completion, about 3 hours | Measurements will be completed every 30 minutes through study completion |
| Number and nature of all reports of adverse events related to furosemide administration | From time of intervention until final disposition, about 6 hours | Adverse events include signs of severe dehydration, allergic reaction, and electrolyte abnormality |
| The time from initiation of the intervention to the time of completion of successful radiology-performed pelvic US | About 3 hours | — |
| The time from initiation of intervention to the time of admission or discharge order placement | From time of intervention until final disposition, about 6 hours | — |
Countries
United States
Outcome results
None listed