Below are a few useful links to resources specific to MUSC Peds Emergency Ultrasound:
Here are a few narrated lectures specific to MUSC Peds Emergency Ultrasound:
  • VERY basic peds echo lecture……this is a narrated version of what we discussed in Fellows conference on 12/11/12
  • Appendix ultrasound lecture……this is the narrated version (with some distracting and sometimes inappropriate content) of the 10-1-13 Fellows conference. There is a 2min period of audio issues at the end of the lecture….sorry.
I will be compiling a list of articles relevant to MUSC Peds Emergency Ultrasound. You can access the "adult" articles by clicking here. The articles below will comprise the core research and reviews with regard to Peds U/S.

  • Appy articles

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    • 2000 Chen et al. AJEM. EP-performed RLQ ultrasound in Taiwan ED.
    • 2006 Doria et al. Radiology. Test characteristics of U/S versus CT for the evaluation of appendicitis.
    • 2008 Fox et al. European J of Emerg Med. EP-performed RLQ U/S in a mixed population of adults and pediatric patients (>60% over age 19yo).
    • 2009 Ramarajan et al. AEM. U/S first approach to appy identification. Using pathway, there was an acceptable negative appy rate of 7% and a missed appy rate of 0.5%. If U/S visualized a normal appendix, no CT needed. If U/S + for appy, then OR. If U/S equivocal (non-visualized), clinical decision-making.
    • 2011 Rosen et al. J Am Coll Radiol. ACR Appropriateness Criteria for appendicitis imaging.
    • 2012 Bachur et al. Annals of EM. The sensitivity of ultrasonography for appendicitis improves with a longer duration of abdominal pain, whereas CT demonstrated high sensitivity regardless of pain duration.
    • 2012 Conners and Schroeder. Annals of EM. Editorial to the Bachur et al article above. Authors demonstrate concern for the U/S first approach based on the findings that the sensitivity of U/S in the first 24hrs of abdominal pain is inadequate. Worth a read (though I disagree to some extent).
    • 2013 Quigley et al. Insights Imaging. Great review of U/S for appendicitis, with emphasis on sono findings and technique.
    • 2013 Russell et al. PEC. Great study confirmed that a clinical practice guideline, emphasizing early pediatric surgical consultation and an "ultrasound-first" approach. Markedly lower CT rates with no incremental increase in missed appy or negative appy rate.

  • Biliary articles

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    • 2010 Tsung et al. AJEM. Case series of biliary U/S on 13 peds patients. All confirmed to have cholecystitis or biliary tract disease. EP-performed ultrasound consistent with radiology U/S or surgical pathology.

  • Cardiac articles

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    • 2004 Pershad et al. Pediatrics. Prospective observational study of 31 critically ill patients. Good agreement between EP's and pediatric echocardiographers with regard to LVEF (shortening fraction) and IVC size.
    • 2005 Spurney et al. J Am Soc Echocardiogr. Study of pediatric critical care physicians trained in basic bedside echo (1hr intro course and 2 hours of practical learning). 23 patients screened with accurate identification of pericardial effusion, LV size, and LV function.
    • 2011 Longjohn et al. PEC. Prospective observational study of PEM physicians regarding POC echo. Good agreement between PEM and pediatric cardiology with regard to LV function, IVC collapsibility, and effusion in a critically ill population.

  • FAST articles

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    • 1997 Akgur et al. J Trauma. Prospective study of 217 children with blunt abdominal trauma. U/S first approach, with 157 normal studies, and 60 abnormal studies (free fluid, organ injury, intrapleural fluid, etc.). Abnormal studies were followed by CT, which generally confirmed the findings.
    • 2009 Sola et al. J Surg Research. FAST combined with AST or ALT measurements > 100 IU/L effectively screens for intra-abdominal injury in children following blunt abdominal trauma. (FAST vs FAST/labs: 50% vs 88% sensitivity, 83% vs 96% NPV.)

  • GI articles

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    • 1999 Suri et al. Acta Radiologica. Compared to CT for the identification of intestinal obstruction, U/S has a sensitivity of 83%, specificity of 100%, and accuracy of 84%. Very low efficacy in determining an etiology for obstruction.
    • 2001 Rettenbacher et al. AJR. U/S for incarcerated hernia (abdominal wall) identification. Sonographic signs: 1) Free fluid in the hernia sac (91% of the incarcerated hernias, 3% of the nonincarcerated hernias) 2) bowel wall thickening in the hernia (88% of the incarcerated hernias, 0% of the nonincarcerated hernias) 3) fluid in the herniated bowel loop (82% of the incarcerated hernias, 3% of the nonincarcerated hernias) and 4) dilated bowel loops in the abdomen (65% of the incarcerated hernias, 0% of the non- incarcerated hernias).
    • 2012 Riera et al. Annals of EM. With limited and focused training, pediatric emergency physicians can accurately diagnose ileocolic intussusception in children by using U/S. Sensitivity 85%, specificity 97%, PPV 85%, and NPV 97%.

  • IVC articles

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    • 2007 Chen et al. AEM. IVC/Aorta ratio is lower in children with dehydration.
    • 2010 Chen et al. AEM. IVC/Aorta ratios marginally accurate in predicting acute weight loss and dehydration in children. IVC/Aorta cutoff of 0.8 produced a sensitivity of 86% and a specificity of 56% for significant dehydration.
    • 2010 Levine et al. AEM. Aorta/IVC ratio (compared to above studies, ratio flipped) is an effective tool for identifying severe dehydration in children. At its best cut-point (1.22), it had a sensitivity of 93% and specificity of 59%.

  • MSK articles

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    • 1997 Chan et al. Acta Radiologica. Hip effusion detection in kids is improved in the extended or abducted position compared to the neutral position.
    • 2007 Chen et al. PEC. Peds EM physicians reliably perform bedside U/S to diagnose forearm fractures (97% sensitivity, 100% specificity).
    • 2009 Patel et al. PEC. U/S comparable to radiography in fracture identification in kids. Also helpful regarding need for reduction and adequacy of reduction. Agreement between plain film and U/S was around 95%.
    • 2011 Chinnock et al. JEM. Prospective study (convenience sample of adult and pediatric patients) of U/S-guided distal radius fracture reduction, compared to historical control. Sensitivity 94%, specificity 56% for identifying a successful reduction. Overall success rates equivalent between U/S and historical control.

  • Ocular articles

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    • 2005 Tsung et al. PEC. Ocular U/S for ICP in children. Establishes upper limit of normal ONSD of 5.0 mm in adults, 4.5 mm in children aged 1-15, and 4.0 mm in infants up to 1 year of age.
    • 2009 Le et al. Annals of EM. Negative study for ICP detection in children. 83% sensitivity and 38% specificity. n=64, used 4.5 and 4.0 cutoffs. A few limitations but the study is generally as good as the others. A little disappointing.

  • Policy articles

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  • Procedural ultrasound articles

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    • Coming soon!

  • Renal articles

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    • 2005 Palmer et al. J Urol. Disappointing study of U/S test characteristics for the identification of urolithiasis. Again, this was a study assessing the ability to detect the actual stone, which we already know is not the strength of bedside ultrasound.

  • Soft tissue articles

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    • 2012 Iverson et al. AJEM. Similar to an adult ED study by Tayal et al, in the Peds ED U/S also led to management changes in the evaluation of soft tissue infections. Smaller effect, though, with 14% management changes.
    • 2013 Marin et al. AEM. Great article looking at the benefit of bedside ultrasound for pediatric soft tissue infections. 387 lesions, with a comparison of the clinical examination and the addition of bedside EUS. For clinically evident lesions, EUS didn't significantly improve accuracy. But for case of uncertainty, EUS improved the sensitivity and specificity of the evaluation.

  • Thoracic articles

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    • 2009 Kerrey et al. Pediatrics. Prospective study of 127 intubated pediatric patients. 91% sensitivity for U/S detection of tracheal placement of ET tube. Agreement between U/S and CXR was 0.83. 50% specificity for main stem intubation. Sonographers used diaphragmatic movement as the indicator of ET placement.

  • Vascular access articles

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