Showing posts with label ultrasound. Show all posts
Showing posts with label ultrasound. Show all posts

Thursday, August 13, 2015

If You Still Think Ultrasound Is the Best Way to Diagnose Cryptorchidism, Think Again.


Todd Huffman
By: Lewis First, MD, MS; Editor-in-Chief       
   
        Despite the fact that the urology literature has indicated that the use of ultrasound for diagnosis of cryptorchidism delays diagnosis and management of this disorder, the practice continues.  This is why Kanaroglou et al. (doi: 10.1542/peds.2015-0222) decided to provide strong evidence against the use of ultrasound as the gold standard of diagnosis for undescended testicle by reviewing the records of boys between 0 and 18 years in Ontario using administrative data as well health records.  The authors looked at to the frequency of ultrasound use as well as time delays between diagnosis and surgical management in those patients who did and did not have ultrasound.   
        Despite the problems using ultrasound to make the diagnosis, sadly in this study the trend to use this modality increased over time resulting in a 3-month delay on average in making the definitive diagnosis and in turn treatment using surgical repair.  So who is still ordering ultrasounds when the clinical diagnosis raises suspicion?   
        Read this article and then tack down what you learn so that ultrasound is not ordered, but a urological or surgical referral is when you suspect your patient has an undescended testicle.

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Friday, May 29, 2015

Taking a Peek at the Accuracy of the Urinalysis for Diagnosing UTIs in Infants


By: Lewis First, MD, MS; Editor-in-Chief       

      The gold standard for diagnosis of a urinary tract infection (UTI) is the urine culture, but just how accurate is the urinalysis itself, especially in young infants?  Schroeder et al. (doi:10.1542/peds.2015-0012) tackled this question through a cross-sectional look at a cohort of 276 infants under three months of age who had a documented UTI based on a urine culture.  The authors then looked at the sensitivity and specificity of the urinalysis findings for infection.    
     More specifically, the authors report on the sensitivity of leukocyte esterase (LE) and of pyuria in the urines studied and the results may surprise you in terms of the accuracy achieved just with the urinalysis.   
     To add more import to this study, we asked Dr. Ken Roberts who chaired the AAP committee that produced the recently revised UTI guidelines to add his perspective on the findings with a commentary (doi:10.1542/peds.2015-0884) also being released this week.  
      If you wonder whether to use the urinalysis findings to help decide whether or not to get a urine culture, go with the flow and read both this study and commentary and see if you want to pay even more attention to the urinalysis results as a diagnostic indicator. 

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Friday, April 3, 2015

Examining The New AAP Framework for Point-of-Care Ultrasound Use

By: Mark Neuman, MD, MPH,  Assistant Editor

     Point-of-care ultrasound is increasingly being used in pediatric emergency departments throughout the United States.  According to recent surveys, ultrasound use increased from 57% among hospitals with pediatric emergency medicine fellowship programs in 2006, to 95% in 2011.  Despite an increase in its use, until now, there have been no published guidelines for the use of point-of-care ultrasound by pediatric emergency physicians. 
      This month’s of Pediatrics contains a technical report (doi:10.1542/peds.2015-0343) and policy statement (doi:10.1542/peds.2015-0342) which provide a framework for point-of-care ultrasound use and training in pediatric emergency medicine. 
     These articles cover the key aspects of developing a point-of-care ultrasonagraphy program in pediatric emergency medicine.  They include information on establishing leadership in ultrasound, necessary equipment, education and training, and interdepartmental considerations. These articles also outline measures for credentialing and assessing and maintaining competency. 
     Does your emergency department utilize point-of-care ultrasound?  Share your thoughts on this issue via response to this blog, an eLetter, or on Facebook or Twitter.

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Thursday, March 6, 2014

Imaging for Appendicitis: US/MRI vs CT—Which Is Better?

Although the CT scan had previously been thought to be the gold standard for imaging someone with suspected appendicitis, the role of ultrasound (US) followed by magnetic resonance imaging (MRI) has been gaining in popularity. So which does a better job?

Photo by Liz West via Flickr
Aspelund et al. (doi: 10.1542/peds.2013-2128) explored this issue by retrospectively reviewing pediatric patients over a 4 year period during which CT was preferred for the first two years (2008-2010) and
ultrasound/MRI for the latter two years. Positive imaging for suspected appendicitis, negative appendectomy rates, perforation rates, and time to antibiotics were studied among other outcome parameters. As to the results, well, you’ll need to read the study to find out, but we think you’ll be on the (cutting) edge of your seats as you learn how each of these imaging modalities performed.

How are you diagnosing appendicitis? We still feel the history and physical can be very sensitive diagnostic tools when performed well—but what do you think? Do you find yourself needing to image your suspected appendicitis patients, or do you send them right to the pediatric surgeon for an operation? If you do image your patients, what do you find as your preferred imaging technique of choice? Would that change as a result of this study?

Let us know by sharing your thoughts via our blog, Facebook or Twitter, or by submitting an eLetter on the Pediatrics website.

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