Hip Effusion, Septic Arthritis, Transient Synovitis, Hip
Conditions
Keywords
Point of Care Ultrasound, Hip Effusion, Pediatric Emergency Medicine
Brief summary
The purpose of this study is to determine if pediatric emergency medicine providers can accurately diagnose a hip effusion using point-of-care ultrasound (POCUS) compared to radiology ultrasound (RADUS).
Detailed description
The purpose of this study is to determine that the accuracy of trained pediatric emergency medicine providers to diagnose hip effusion using point-of-care ultrasound (POCUS) is non-inferior to the reference standard of radiology ultrasound (RADUS). Additionally, the investigators seek to compare how POCUS performs against other clinical tests or investigations for the diagnosis of septic arthritis. The investigators hypothesize that trained EM providers will be able to diagnose hip effusions with high (\>90%) accuracy compared to studies conducted by the Department of Radiology.
Interventions
None listed
Sponsors
Columbia University
Newark Beth Israel Medical Center
Cohen Children's Medical Center
Gold Coast Hospital and Health Service
Yale University
Connecticut Children's Medical Center
Study design
Observational model
OTHER
Time perspective
PROSPECTIVE
Eligibility
Sex/Gender
ALL
Age
1 Months to 18 Years
Healthy volunteers
No
Inclusion criteria
* Age 18 years or younger * Clinical presentation necessitating hip ultrasonography as determined by the evaluating clinician * Study physician available at the time of presentation to ED * Patient or legal guardian provides consent
Exclusion criteria
* Children who present when a study physician is not available or those for whom consent is not given. * Children who have had hip ultrasound imaging prior to their ED visit. Children with prior hip/pelvis x-rays will not be excluded.
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| The presence or absence of a hip effusion. | From the time the point-of-care ultrasound is performed by the physician during the emergency department visit through study completion, average of 2 years. | The presence or absence of an effusion as determined by the pediatric emergency medicine physician performing the point-of-care-ultrasound study on both the affected and unaffected sides (i.e. right hip and left hip). |
| The presence of absence of a hip effusion. | From the time the radiologist reviews the ultrasound as performed by the radiology technician during the emergency department visit, through study completion, average of 2 years. | The presence or absence of an effusion as determined by the Radiologist on both the affected and unaffected sides. |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| The size of the effusion. | From the time the point-of-care ultrasound is performed by the physician during the emergency department visit to study completion, average of 2 years | As measured by the pediatric emergency medicine provider in millimeters. |
| The location of the measurement of the effusion. | Upon chart review: between the time the measurement was obtained in the emergency department up to six weeks later when the chart is reviewed by primary investigator. | Pediatric emergency medicine physicians will measure an effusion at two designated locations. One location is based off of current published literature whereas the second is to provide a comparison to determine if the exact location alters the final diagnosis (effusion or no effusion). Investigators will determine whether the location along the angle of the neck affects the measurement obtained when compared with the current standard practice of measuring fluid along the widest part of the femoral neck. |
Other
| Measure | Time frame | Description |
|---|---|---|
| Number of point-of-care ultrasound studies performed by PEM providers that have a different final diagnosis when compared to radiology ultrasound. | Upon chart review: between the time the measurement was obtained in the emergency department up to six weeks later when the chart is reviewed by primary investigator. | Investigators will compare the final diagnosis (hip effusion or no hip effusion) between point-of-care-ultrasound and radiology ultrasound to determine the number of discrepancies between the groups. |
| Association between point-of-care ultrasound and Kocher score (0-4). | Upon chart review: between the time the measurement was obtained in the emergency department up to six weeks later when the chart is reviewed by primary investigator. | Investigators will determine if the addition of ultrasonography results coupled with Kocher score (0-4; increased risk of septic arthritis with higher scores), which includes laboratory markers, increases the likelihood of septic arthritis. |
Countries
Australia, United States
Outcome results
None listed