Evaluation of a Point-of-Care Ultrasonography Decision-Support Algorithm for the Diagnosis of Transient Synovitis in the Pediatric Emergency Department

Abstract

Transient synovitis (TS) is a self-limiting disease characterized clinically by acute hip pain. The diagnosis is confirmed by excluding other severe diseases, such as septic arthritis, osteomyelitis, and Legg-Calvé-Perthes disease. Ultrasonography examination frequently reveals hip effusion. 1,2 A point-of-care ultrasonography (POCUS) decision-support algorithm (DSA) is regularly used to identify TS in the pediatric emergency department (ED) of Rambam Health Care Campus, a tertiary hospital in Haifa, Israel. 2,3 The POCUS-DSA includes a set of 5 clinical criteria that must be met, followed by bedside ultrasonography examination of the hip joint (Figure ). 1,2 Here, we evaluate the performance of the POCUS-DSA in the diagnosis of TS among children presenting to the pediatric ED. MethodsThis study was approved by the Rambam Health Care Campus ethics committee. Informed consent was not necessary because of the retrospective nature of the study, in accordance with Rambam Health Care Campus policy. The reporting guideline for case series was used for this study. This case series analyzed all children with nontraumatic hip tenderness who met the POCUS-DSA criteria between January 1, 2014, and December 31, 2019. Ultrasonography was performed using an accepted technique. 2 Patients with hip effusion received a diagnosis of TS in the ED and were scheduled for a follow-up visit in 5 to 7 days. Patients without hip effusion were assessed with laboratory or imaging tests, as per clinician judgment (Figure). 2 A final diagnosis of TS was made for any patient who had spontaneous resolution of symptoms and a reduction in the amount of effusion at the follow-up visit. 1 Sensitivity, specificity, positive predictive value (PPV), negative predictive value (NPV), positive likelihood ratio (LR), and negative LR were used to assess Author affiliations and article information are listed at the end of this article.

Establishing the international research priorities for pediatric emergency medicine point‐of‐care ultrasound: A modified Delphi study

“…POCUS is superior to x‐ray in detecting a hip effusion and can guide arthrocentesis but cannot readily determine etiology 40–42 . Therefore, larger trials are required to validate an algorithm incorporating POCUS with clinical and laboratory findings to differentiate transient synovitis from septic arthritis 43 …”

“… 40 , 41 , 42 Therefore, larger trials are required to validate an algorithm incorporating POCUS with clinical and laboratory findings to differentiate transient synovitis from septic arthritis. 43 …”

“…[40][41][42] Therefore, larger trials are required to validate an algorithm incorporating POCUS with clinical and laboratory findings to differentiate transient synovitis from septic arthritis. 43 Ileocolic intussusception can be a life-threatening condition in infants and young children that can be elusive to diagnose on clinical grounds alone. 44 POCUS has been demonstrated to be noninferior to radiology performed ultrasound in a large multicenter prospective trial but was limited by convenience sampling, which could be mitigated by consecutive recruitment in a randomized controlled trial.…”

Sinovitis transitoria de cadera: Diagnóstico diferencial y abordaje diagnóstico

“…Esta patología se presenta con mayor frecuencia en pacientes masculinos en comparación con pacientes femeninas, en aproximadamente una relación de 2:1. La edad de presentación típica es entre los tres y ocho años de edad, pero en la literatura se han descrito casos desde los 18 meses de edad hasta los 12 años (7,8).…”

“…En los pocos casos en los cuales se ha llegado a obtener muestras para toma de biopsia, se ha documentado inflamación inespecífica en los estudios histopatológicos (7). Otros factores de riesgo propuestos para el desarrollo de esta enfermedad, aunque menos frecuentes que las IVRS, incluyen algunas infecciones bacterianas como la estreptocócica y el antecedente de trauma (8).…”