1
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Erkel D, Märzheuser S, Lindert J. Assessing fecal load with ultrasound in children with colorectal pathology: ReKiSo study. Pediatr Surg Int 2024; 40:202. [PMID: 39030300 PMCID: PMC11271418 DOI: 10.1007/s00383-024-05771-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 07/04/2024] [Indexed: 07/21/2024]
Abstract
PURPOSE To evaluate bowel management for children with colorectal pathology by measuring transverse rectal diameter (TRD) and assessing fecal load with transabdominal rectal ultrasound (TRU). METHODS Prospective case-control study of children receiving bowel management (BM) between 04/2023 and 04/2024 was done. There was inclusion of patients with Hirschsprung disease (HD), anorectal malformation (ARM) and functional constipation (FC). Patients with other congenital or neurological conditions were excluded. Control group consisted of inpatients and outpatients without abdominal complaints. FC was diagnosed according to ROM-IV-criteria. For HD and ARM, we followed a list of symptoms. To assess fecal load, we visualized the TRD using the Klijn (Klijn et al. in J Urol 172:1986-1988, 2004) method. The bladder was moderately full. The fecal load was assessed retrograde from the rectum. Follow-up was at 1/3/6 months. Secondary data were collected from medical records. Sample size calculated a priori and follow-up group with new gathered data. RESULTS p value for TRD in all groups significant with p < 0.05 and in grouped follow-up. CONCLUSION Ultrasound is a useful tool for assessing fecal load and helps diagnose constipation and monitor BM. Irrespective of colorectal pathology, a cut-off of 3 cm seems to discriminate between children without constipation/overload symptoms and asymptomatic patients. We present a radiation-free method for monitoring bowel management.
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Affiliation(s)
- Daniel Erkel
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann-Straße 8, 18057, Rostock, Germany.
| | - Stefanie Märzheuser
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann-Straße 8, 18057, Rostock, Germany
| | - Judith Lindert
- Department of Pediatric Surgery, University Hospital Rostock, Ernst-Heydemann-Straße 8, 18057, Rostock, Germany
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2
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Rodriguez L. Testing in functional constipation-What's new and what works. Aliment Pharmacol Ther 2024; 60 Suppl 1:S30-S41. [PMID: 38940015 DOI: 10.1111/apt.17857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Revised: 11/17/2023] [Accepted: 12/14/2023] [Indexed: 06/29/2024]
Abstract
BACKGROUND Constipation is among the most common symptoms prompting a consultation with a paediatric gastroenterologist. While most patients will respond to lifestyle and dietary changes and conventional therapy, some may require diagnostic studies. AIM To review the diagnostics studies used to evaluate children with functional constipation. MATERIALS AND METHODS There is no evidence to support the routine use of abdominal X-rays in the evaluation of paediatric constipation. Colon transit by radiopaque markers (ROM) should be indicated when medical history does not match clinical findings, to guide colon manometry (CM) performance and to discriminate between faecal incontinence from functional constipation and non-retentive faecal incontinence. Colon scintigraphy may be useful as an alternative to ROM. Lumbar spine MRI may be indicated to evaluate for spinal abnormalities. The role of defecography has not been properly evaluated in children. Anorectal manometry in children is indicated primarily to evaluate anal resting pressure, presence and quality of the recto-anal inhibitory reflex and simulated defecation manoeuvres. The CM is indicated to guide surgical interventions after failing medical therapy. CONCLUSIONS The goal of these studies is to identify treatable causes of constipation. Most of these studies are designed to evaluate anatomy, transit and/or colon/rectum motility function and are primarily indicated in those who fail to respond to conventional therapy.
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Affiliation(s)
- Leonel Rodriguez
- Section of Pediatric Gastroenterology, Hepatology and Nutrition, Yale New Haven Children's Hospital, Yale University School of Medicine, New Haven, Connecticut, USA
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3
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Mathias RM, Chu MKW, Edwards S, Day AS, Ma C, Jairath V, Bryant RV. Meta-analysis: Intestinal ultrasound to evaluate colonic contents and constipation. Aliment Pharmacol Ther 2024; 60:6-16. [PMID: 38745540 DOI: 10.1111/apt.18029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/04/2023] [Revised: 01/02/2024] [Accepted: 04/18/2024] [Indexed: 05/16/2024]
Abstract
BACKGROUND Constipation can be diagnosed clinically using the Rome criteria. Ultrasound (US), which lacks the radiation exposure of conventional X-ray, holds promise as a non-invasive tool to evaluate colonic contents and constipation. AIM To examine the role of US in the assessment of constipation. METHODS We performed a systematic search of Embase (OVID, 1984), Medline (Ovid, 1946), Cochrane Central, ClinicalTrials.gov and Australia New Zealand Clinical Trials Registry from database inception to 26 January 2024 according to PRISMA guidelines and prospectively registered with PROSPERO. All studies using US to assess constipation or colonic contents in either adults or children were included. Rectal diameter measurements were pooled in meta-analysis. Risk of bias was assessed using the Newcastle Ottawa Scales and Joanna Briggs Institute checklists. RESULTS Of 12,232 studies screened, 51 articles (6084 patients; 3422 children) describing US to assess symptoms in patients with constipation were included. Most studies used Rome criteria to diagnose constipation. Rectal diameter was associated with clinical constipation in 29 paediatric studies (3331 patients). Meta-analysis showed the mean rectal diameter of constipated patients was significantly higher than controls (mean difference 12 mm, 95% confidence intervals (CI): 6.48, 17.93, p < 0.0001, n = 16 studies). Other features of constipation on US included posterior acoustic shadowing and echogenicity of luminal contents. CONCLUSION US is an appealing imaging modality to assess luminal contents and constipation. Further well-designed studies are required to validate US metrics that accurately identify constipation.
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Affiliation(s)
- R M Mathias
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - M K W Chu
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - S Edwards
- School of Public Health, The University of Adelaide, Adelaide, South Australia, Australia
| | - A S Day
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
| | - C Ma
- Division of Gastroenterology & Hepatology, Department of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
- Alimentiv Inc., London, Ontario, Canada
| | - V Jairath
- Alimentiv Inc., London, Ontario, Canada
- Division of Gastroenterology, Department of Medicine, London Health Sciences Centre, Western University, London, Ontario, Canada
- Department of Epidemiology and Biostatistics, Western University, London, Ontario, Canada
| | - R V Bryant
- Inflammatory Bowel Disease Service, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia
- Inflammatory Bowel Disease Research Group, The Basil Hetzel Institute for Translational Health Research, Adelaide, South Australia, Australia
- School of Medicine, Faculty of Health and Medical Sciences, The University of Adelaide, Adelaide, South Australia, Australia
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4
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Riera A, Phatak UP. Qualitative Point-of-Care Ultrasound Enema Management for Constipation. Pediatr Emerg Care 2024; 40:239-242. [PMID: 37890187 DOI: 10.1097/pec.0000000000003081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/29/2023]
Abstract
ABSTRACT We discuss 10 cases where the qualitative evaluation of hard stool in the rectum with point-of-care ultrasound helped guide enema administration in a pediatric emergency department. Point-of-care ultrasound findings were especially valuable in cases where the presenting symptoms were undifferentiated, a language barrier was present, or the guardian and child denied that constipation was an active problem. When sodium phosphate enema administration was done in the pediatric emergency department, evacuation of the rectal stool burden was observed in most cases before final disposition.
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Affiliation(s)
- Antonio Riera
- From the Yale University School of Medicine, Pediatric Emergency Medicine
| | - Uma P Phatak
- Yale University School of Medicine; Pediatric Gastroenterology
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5
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Comisi F, Esposito E, Marras M, Soddu C, Savasta S. Unusual Inconsolable Crying: An Insight, Case Report, and Review of the Literature on the Pitt-Hopkins Gastrointestinal Phenotype. Cureus 2023; 15:e43781. [PMID: 37731434 PMCID: PMC10507423 DOI: 10.7759/cureus.43781] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/20/2023] [Indexed: 09/22/2023] Open
Abstract
Pitt-Hopkins syndrome (PTHS) is a rare, neurodevelopmental genetic disorder caused by mutations in the TCF4 gene. This gene encodes a ubiquitous, class I, basic helix-loop-helix factor, which is implicated in various developmental and regulatory processes. Predominant clinical manifestations of PTHS include facial dysmorphisms, intellectual disability, absence of expressive language, epilepsy, as well as visual and musculoskeletal impairments. Gastrointestinal (GI) complications, such as chronic intestinal pseudo-obstruction, gastroparesis with delayed bowel transit, chronic constipation culminating in failure to thrive, and gastroesophageal reflux disease (GERD), are also prevalent in these patients. The early identification of pain etiology in PTHS patients poses a significant clinical challenge. This report presents two cases of PTHS patients suffering from gastrointestinal dysmotility, evaluated at our Pediatrics Clinic at the "Microcitemico" Hospital. A review of existing literature was conducted via the PubMed database to elucidate the current understanding of the GI phenotype in PTHS. Twenty articles were deemed most relevant and selected for this purpose. In both patients, severe constipation and abdominal distension resulted in persistent agitation and inconsolable crying. These distress symptoms were completely ameliorated following prompt pharmacological intervention.
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Affiliation(s)
| | - Elena Esposito
- Pediatrics Department, Ospedale Microcitemico, Cagliari, ITA
| | | | | | - Salvatore Savasta
- Pediatric and Rare Diseases Clinic, Ospedale Microcitemico, Cagliari, ITA
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6
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Scheier E, Brenner G, Oren S. A Surprising Lead Point in an Ileocolic Intussusception. Pediatr Emerg Care 2023; 39:108-111. [PMID: 36252058 DOI: 10.1097/pec.0000000000002861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
ABSTRACT Appendicitis and intussusception are 2 of the most common abdominal emergencies in children and have high rates of morbidity if not treated promptly. However, only rarely do they occur together. We present a case in which clinical suspicion for intussusception was not high. Point-of-care ultrasound (POCUS) was performed in the pediatric emergency department, revealing both ileocolic intussusception and appendicitis. This case reinforces the importance of maintaining a broad differential diagnosis in unclear clinical scenarios and of the potential utility of POCUS. In our case, identification of intussusception on POCUS facilitated expeditious treatment, identification of the lead point, and allowed the treating physicians to prepare for the possibility of surgical management.
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7
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Hamdy AM, Sakr HM, Boules IS, Awad YMM. The role of rectal ultrasound in children with functional constipation. J Paediatr Child Health 2023; 59:533-536. [PMID: 36718568 DOI: 10.1111/jpc.16344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Revised: 01/12/2023] [Accepted: 01/14/2023] [Indexed: 02/01/2023]
Abstract
AIM The study aimed primarily to compare the transverse rectal diameter in children with functional constipation (FC) and children without constipation in different age groups, and between cases of constipation at baseline and after treatment. Secondary aim was to determine factors that could affect the transverse rectal diameter. METHODS A controlled prospective study, including a total of 100 children between the ages of 2 and 11 years, who were divided into 50 patients suffering from constipation according to Rome IV criteria and 50 age- and sex-matched controls. Transverse rectal diameter was measured at presentation, and after 3 months of laxative therapy and behavioural modification. RESULTS Initial rectal diameter was significantly different between cases (3.55 cm (interquartile range, IQR), 3.2-4) and controls (2.3 cm (IQR, 1.8-2.5)), P value < 0.001, and it was also significantly different between those above and below 4 years, so a separate cut-off point for diagnosis of constipation was suggested being >3 cm for the former and >2.5 cm for the latter. After 3 months of follow-up, rectal diameter significantly reduced to become 2.6 (IQR, 2-2.8), P value < 0.001. Duration of symptoms positively correlated with rectal diameter. CONCLUSIONS Ultrasound measurement of rectal diameter is an important tool to diagnose and follow-up functional constipation in children. Different values of rectal diameter are found between those above and below 4 years of age.
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Affiliation(s)
- Ahmed M Hamdy
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Hossam M Sakr
- Radiology Department, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Ireny S Boules
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
| | - Yosra M M Awad
- Department of Pediatrics, Faculty of Medicine, Ain Shams University, Cairo, Egypt
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8
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Shapouri S, Matani R, Salahshoor A, Qorbani M, Hosseini A, Norouzi M, Khavandegar A. Rectal measurements and their correlation with bowel habits: Evaluation by trans-abdominal ultrasound in children with functional constipation. J Paediatr Child Health 2022; 58:1792-1796. [PMID: 35778914 DOI: 10.1111/jpc.16104] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 06/16/2022] [Accepted: 06/19/2022] [Indexed: 11/29/2022]
Abstract
AIM Constipation is one of the most common complaints in childhood affecting the quality of life of both children and parents. This study intends to investigate rectal measurements on ultrasound and their relationship with bowel habits. METHODS In this cross-sectional study, 100 children with functional constipation (FC) referred to a single hospital between 2018 and 2019 were enrolled. After obtaining informed consent, a questionnaire including demographic and constipation characteristics was completed, and a physical examination including digital rectal examination (DRE) was performed. Complete abdominopelvic ultrasound was then performed. Target measurements included rectal transverse diameter (RTD), rectal anterior wall thickness (RAWT) and the presence of faecal impaction. RESULTS One hundred children with a mean age of 7.68 ± 3.30 years were present in the study. The mean duration of constipation was 15.86 ± 13.34 months. In 14% of children, painful defaecation was reported. 88% of children had some degree of faecal incontinence. According to the ultrasound findings, the mean RTD and RAWT were 3.39 ± 0.73 cm and 2.77 ± 0.68 mm, respectively, and faecal impaction was present in 70% of cases. There was a positive correlation between RTD and RAWT with age, duration of constipation and the presence of hard stools, and there was a negative correlation with frequency of defecation (P < 0.05). CONCLUSION RTD and RAWT increased with increasing constipation duration and the presence of hard stools and decreased with increasing frequency of defaecation. DRE could be omitted from the initial clinical assessment if you had access to reliable ultrasound data.
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Affiliation(s)
- Samaneh Shapouri
- Pediatrics Medicine Department, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Rahman Matani
- Pediatrics Medicine Department, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Ali Salahshoor
- Radiology Department, Alborz University of Medical Sciences, Karaj, Iran
| | - Mostafa Qorbani
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Amirhossein Hosseini
- Pediatric Gastroentrology, Hepatology and Nutrition Research Center, Research Institute for Children's Health, Shahid Beheshti University of Medical sciences, Tehran, Iran
| | - Mahsa Norouzi
- Pediatrics Medicine Department, Imam Ali Hospital, Alborz University of Medical Sciences, Karaj, Iran
| | - Armin Khavandegar
- Student Research Committee, Alborz University of Medical Sciences, Karaj, Iran
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9
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McGinness A, Lin-Martore M, Addo N, Shaahinfar A. The unmet demand for point-of-care ultrasound among general pediatricians: a cross-sectional survey. BMC MEDICAL EDUCATION 2022; 22:7. [PMID: 34980087 PMCID: PMC8722332 DOI: 10.1186/s12909-021-03072-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2021] [Accepted: 12/01/2021] [Indexed: 06/14/2023]
Abstract
BACKGROUND Point-of-care ultrasound (POCUS) is a noninvasive bedside tool with many pediatric applications but is not currently a formal part of pediatric training and practice. Formal surveys of general pediatricians regarding POCUS training are lacking. We aimed to quantify the baseline ultrasound experience and training needs of general pediatricians and pediatric residents across different practice settings. METHODS In 2020, we sent an online survey to 485 current faculty, residents, and graduates from an urban pediatric academic medical center in Northern California. Pediatric subspecialists were excluded. Survey questions about baseline experience, comfort, and perceived usefulness of 20 common POCUS applications were developed by two POCUS experts using existing literature. Chi-squared analysis was used to compare residents versus attendings and to compare attendings practicing in inpatient versus outpatient versus mixed settings. RESULTS Response rate was 20% (98/485). Compared to attendings (n = 73), residents (n = 25) endorsed more exposure to POCUS in medical school (32% vs 5%, p = 0.003) and residency (12% vs 5%, p = 0.003). Respondents endorsed low comfort with POCUS (mean 1.3 out of 5 on Likert scale). Of 20 procedural and diagnostic applications, respondents identified abscess drainage, bladder catheterization, soft tissue, neck, advanced abdominal, and constipation as most useful. Overall, 50% of pediatricians (and 70% of pediatric residents) responded that there were opportunities to use POCUS multiple times a week or more in their clinical practice. CONCLUSIONS There is an unmet demand for POCUS training among general pediatricians and trainees in our study. Although the majority of respondents were not POCUS users, our results could guide future efforts to study the role of POCUS in general pediatrics and develop pediatric curricula.
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Affiliation(s)
- Anelah McGinness
- Department of Graduate Medical Education, PGY-3 resident, University of California San Francisco Benioff Children’s Hospital Oakland, 747 52nd Street, Suite 245, Oakland, CA 94609 USA
| | - Margaret Lin-Martore
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco, 5150 16th St, Box 0632, San Francisco, CA 94143 USA
| | - Newton Addo
- Departments of Medicine and Emergency Medicine, 1001 Potrero Ave, Box 1220, San Francisco, CA 94143 USA
| | - Ashkon Shaahinfar
- Departments of Emergency Medicine and Pediatrics, University of California San Francisco Benioff Children’s Hospital Oakland, University of California San Francisco, 747 52nd Street, ED Trailer 3, Oakland, CA 94609 USA
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10
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Wang X, Nie F, Li Y, Li J. Ultrasonographic Features of Hypertrophic Interureteral Cristae in Transabdominal and Transrectal Ultrasonography. Ultrasound Q 2021; 37:244-247. [PMID: 34478422 DOI: 10.1097/ruq.0000000000000481] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim of this study was to determine the value of transrectal ultrasound in the definitive diagnosis of hypertrophic interureteral cristae and to provide a definitive diagnostic basis for clinical treatment. MATERIALS AND METHODS When the patient's bladder fills moderately, the ultrasound physician uses the transabdominal ultrasound probe to examine the patient's bladder and prostate carefully, focusing on bilateral ureterovesical portals, a cord-like hyperechoic structure visible between the bilateral ureterovesical portals. For further detailed observation, transrectal probe was used to measure the size of Hypertrophic Interureteral Cristae and describe the shape and internal echo. After the examination, the residual urine volume of bladder was measured after one-time urination. RESULTS Hypertrophic interureteral cristae was a trilinear structure with a "high-low-high" echo. All the 33 patients had bladder wall thickening. In 9 cases of overfilling of bladder, there were slightly dilated ureterovesical portals at both ends of hypertrophic interureteral cristae. Thirty cases of benign prostatic hyperplasia, 11 patients who had undergone prostate hyperplasia surgery, 26 cases with different degrees trabecular and reticular hyperplasia of bladder wall, there were 9 cases with bladder diverticulum and 23 cases with mild hydronephrosis. CONCLUSIONS Transrectal ultrasound can confirm the diagnosis of Hypertrophic Interureteral Cristae.
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Affiliation(s)
- Xiaofeng Wang
- Department of Ultrasound, The Second Hospital of Lanzhou University, Lanzhou, Gansu, China
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11
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Pop D, Tătar S, Fufezan O, Farcău D. Rectum sizes: Assessment by ultrasonography in children with functional constipation. J Paediatr Child Health 2021; 57:1244-1249. [PMID: 33665902 DOI: 10.1111/jpc.15435] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Revised: 01/30/2021] [Accepted: 02/23/2021] [Indexed: 12/27/2022]
Abstract
AIM This study aimed to compare the transverse diameter and thickness of the anterior wall of the rectum in children with normal bowel movement and children with functional constipation in different age groups. Another objective was to find correlations of rectum sizes with faecal incontinence and constipation duration. METHODS In the study, we included children with normal bowel movement and functional constipation diagnosed based on the Rome III and Rome IV criteria. We collected clinical data from the parents. We measured the rectum transverse diameter and the thickness of the anterior wall by abdominal ultrasound. RESULTS The study included 65 children, 31 with normal bowel movement and 34 with functional constipation. The rectum transverse diameter and the thickness of the anterior wall had statistically significant higher values in patients with constipation (P < 0.05). There was a moderate and significant correlation between the duration of the disease (mean ± standard deviation = 31.7 ± 33.1 months) and rectum transverse diameter (r = 0.54; P = 0.0009). The rectum transverse diameter correlated moderately with the presence of faecal incontinence (r = 0.62; P = 0.003), but the thickness of the anterior wall did not correlate with this symptom (r = 0.02; P = 0.39). CONCLUSIONS We found statistically significant differences between the transverse rectal diameter and thickness of the rectum anterior wall, measured by abdominal ultrasound, in children with functional constipation compared with normal defaecation patterns. Faecal incontinence and long-term constipation were correlated with the increased rectum diameter.
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Affiliation(s)
- Daniela Pop
- 3rd Pediatric Discipline, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Tătar
- 3rd Pediatric Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Otilia Fufezan
- Radiology Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Dorin Farcău
- 3rd Pediatric Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania.,Nursing Discipline, "Iuliu Hatieganu" University of Medicine and Pharmacy, Cluj-Napoca, Romania
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12
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van Wassenaer EA, Daams JG, Benninga MA, Rosendahl K, Koot BGP, Stafrace S, Arthurs OJ, van Rijn RR. Non-radiologist-performed abdominal point-of-care ultrasonography in paediatrics - a scoping review. Pediatr Radiol 2021; 51:1386-1399. [PMID: 33837798 PMCID: PMC8266706 DOI: 10.1007/s00247-021-04997-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Revised: 10/06/2020] [Accepted: 02/03/2021] [Indexed: 12/16/2022]
Abstract
BACKGROUND Historically, US in the paediatric setting has mostly been the domain of radiologists. However, in the last decade, there has been an uptake of non-radiologist point-of-care US. OBJECTIVE To gain an overview of abdominal non-radiologist point-of-care US in paediatrics. MATERIALS AND METHODS We conducted a scoping review regarding the uses of abdominal non-radiologist point-of-care US, quality of examinations and training, patient perspective, financial costs and legal consequences following the use of non-radiologist point-of-care US. We conducted an advanced search of the following databases: Medline, Embase and Web of Science Conference Proceedings. We included published original research studies describing abdominal non-radiologist point-of-care US in children. We limited studies to English-language articles from Western countries. RESULTS We found a total of 5,092 publications and selected 106 publications for inclusion: 39 studies and 51 case reports or case series on the state-of-art of abdominal non-radiologist point-of-care US, 14 on training of non-radiologists, and 1 each on possible harms following non-radiologist point-of-care US and patient satisfaction. According to included studies, non-radiologist point-of-care US is increasingly used, but no standardised training guidelines exist. We found no studies regarding the financial consequences of non-radiologist point-of-care US. CONCLUSION This scoping review supports the further development of non-radiologist point-of-care US and underlines the need for consensus on who can do which examination after which level of training among US performers. More research is needed on training non-radiologists and on the costs-to-benefits of non-radiologist point-of-care US.
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Affiliation(s)
- Elsa A van Wassenaer
- Emma Children's Hospital, Amsterdam UMC, Paediatric Gastroenterology, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands. .,Amsterdam Reproduction and Development, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands. .,Amsterdam Gastroenterology and Metabolism,Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands.
| | - Joost G Daams
- Amsterdam UMC, Medical Library, University of Amsterdam, Amsterdam, The Netherlands
| | - Marc A Benninga
- Emma Children's Hospital, Amsterdam UMC, Paediatric Gastroenterology, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Karen Rosendahl
- Department of Radiology, Section of Paediatric Radiology, University Hospital North Norway, Tromsø, Norway.,Department of Clinical Medicine, Faculty of Health Sciences, UiT the Arctic University of Norway, Tromsø, Norway
| | - Bart G P Koot
- Emma Children's Hospital, Amsterdam UMC, Paediatric Gastroenterology, University of Amsterdam, Meibergdreef 9, 1105AZ, Amsterdam, The Netherlands
| | - Samuel Stafrace
- Division of Body imaging, Department of Diagnostic Imaging, Sidra Medicine and Weill Cornell Medicine, Doha, Qatar
| | - Owen J Arthurs
- Department of Radiology, Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,NIHR Great Ormond Street Biomedical Research Centre, London, UK
| | - Rick R van Rijn
- Amsterdam UMC, Radiology, University of Amsterdam, Amsterdam, The Netherlands
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13
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Kim MJ, Choi YJ, Lee JH, Kwon H, Suh D. The Appropriateness of Glycerin Enema in Pediatric Patients Visiting the Emergency Department. CHILDREN-BASEL 2021; 8:children8050364. [PMID: 34063250 PMCID: PMC8147433 DOI: 10.3390/children8050364] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 04/23/2021] [Accepted: 04/28/2021] [Indexed: 11/16/2022]
Abstract
Objectives: We determined whether glycerin enemas were appropriately prescribed in pediatric fecal impaction patients using the Leech score and identified factors that influenced the prescription of glycerin enemas in the pediatric emergency department (PED). Methods: We included patients who received a glycerin enema at the PED of a tertiary teaching hospital. We divided the study subjects into two groups on the basis of their Leech scores: an appropriate enema group (Leech score ≥ 8), and an inappropriate enema group (Leech score < 8). Logistic regression was performed to determine the factors associated with glycerin enema administration. Results: The data of 998 patients, including 446 patients in the inappropriate enema group (Leech score 5.2 ± 1.7) and 552 patients in the appropriate enema group (Leech score 10.1 ± 1.7), were analyzed. A discharge diagnosis of fecal impaction was observed significantly more frequently (57.1%) in the appropriate enema group, and nonspecific abdominal pain (8.3%) and acute gastroenteritis (40.8%) were diagnosed significantly more frequently in the inappropriate enema group (p < 0.05). Constipation (2.8%) and irritability (3.0%) were slightly more common in the appropriate enema group than in the inappropriate enema group (p < 0.05). According to multiple logistic regression, subjects aged 2–8 years (2–4 years, OR 4.24; 4–8 years, OR 2.83), with vomiting (OR 1.72), with irritability (OR 4.52), and with a prolonged last defecation day (OR 1.2) were most likely to receive appropriate enema administration (p < 0.05). Conclusion: The results showed that in those aged 2–8 years, with vomiting and irritability, and with a prolonged last defecation day, an enema was generally administered appropriately.
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Affiliation(s)
- Min-Jung Kim
- Department of Emergency Medicine, CHA Bundang Medical Center, CHA University, Gyeonggi-do 13496, Korea;
| | - Yoo-Jin Choi
- Department of Emergency Medicine, Ajou University School of Medicine, Gyeonggi 16499, Korea;
| | - Jin-Hee Lee
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi 13620, Korea; (H.K.); (D.S.)
- Correspondence: or ; Tel.: +82-31-787-7586
| | - Hyuksool Kwon
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi 13620, Korea; (H.K.); (D.S.)
| | - Dongbum Suh
- Department of Emergency Medicine, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Gyeonggi 13620, Korea; (H.K.); (D.S.)
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14
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Pop D, Tătar S, Fufezan O, Farcău D. Changes in the parameters of the rectoanal inhibitory reflex in children with functional constipation and large rectum. Med Pharm Rep 2021; 94:73-78. [PMID: 33629052 PMCID: PMC7880069 DOI: 10.15386/mpr-1894] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Revised: 09/23/2020] [Accepted: 10/12/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Abdominal ultrasound and anorectal manometry are part of the investigations used to assess children with functional constipation. This study aimed at assessing the changes in the characteristics of the rectoanal inhibitory reflex (RAIR) in children with functional constipation and correlating them with the dimensions of the rectum, measured by abdominal ultrasound. A secondary objective was to compare the rectum size in children with and without constipation. METHOD We retrospectively reviewed the clinical data and investigations results of 51 children (mean age±standard deviation (SD) = 5.8±3.5 years) with functional constipation who came to our clinic between January 2013 and February 2020. The assessment of these patients included both the assessment of the transverse diameter of the rectal ampulla by abdominal ultrasound and anorectal manometry. The studied parameters of RAIR were: the minimal volume of air necessary to induce RAIR, in all the patients with functional constipation, and in 20 of them, relaxation time, latency and relaxation percentage. A control group was formed of 27 children (mean age±SD = 5.1±4 years) without digestive diseases and with normal intestinal transit, who were assessed by abdominal ultrasound. RESULTS The mean value ±SD of the volume of air necessary to induce RAIR was 21.9±12.1 cm3 air. There was no correlation between the rectum transverse diameter and the minimal air volume that triggered RAIR (r=-0.01, p=0.94). The mean value ±SD of the transverse diameter of the rectum in patients with functional constipation was 39±14 mm, and in children without constipation 26±6 mm (p<0.05). The mean duration of the symptoms in children with functional constipation was 2.8 years. CONCLUSIONS There were no correlations between the volume of air that induced the RAIR and the transverse diameter of the rectum in children with functional constipation. The transverse diameter of the rectum was increased in children with long-term functional constipation.
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Affiliation(s)
- Daniela Pop
- Mother and Child Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
| | - Simona Tătar
- 3 Pediatric Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Otilia Fufezan
- Radiology Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
| | - Dorin Farcău
- Mother and Child Department, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania
- 3 Pediatric Department, Clinical Emergency Hospital for Children, Cluj-Napoca, Romania
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15
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Sorensen B, Hunskaar S. Point-of-care ultrasound in primary care: a systematic review of generalist performed point-of-care ultrasound in unselected populations. Ultrasound J 2019; 11:31. [PMID: 31749019 PMCID: PMC6868077 DOI: 10.1186/s13089-019-0145-4] [Citation(s) in RCA: 59] [Impact Index Per Article: 11.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2019] [Accepted: 10/21/2019] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Both the interest and actual extent of use of point-of-care ultrasound, PoCUS, among general practitioners or family physicians are increasing and training is also increasingly implemented in residency programs. However, the amount of research within the field is still rather limited compared to what is seen within other specialties in which it has become more established, such as in the specialty of emergency medicine. An assumption is made that what is relevant for emergency medicine physicians and their populations is also relevant to the general practitioner, as both groups are generalists working in unselected populations. This systematic review aims to examine the extent of use and to identify clinical studies on the use of PoCUS by either general practitioners or emergency physicians on indications that are relevant for the former, both in their daily practice and in out-of-hours services. METHODS Systematic searches were done in PubMed/MEDLINE using terms related to general practice, emergency medicine, and ultrasound. RESULTS On the extent of use, we identified 19 articles, as well as 26 meta-analyses and 168 primary studies on the clinical use of PoCUS. We found variable, but generally low, use among general practitioners, while it seems to be thoroughly established in emergency medicine in North America, and increasingly also in the rest of the world. In terms of clinical studies, most were on diagnostic accuracy, and most organ systems were studied; the heart, lungs/thorax, vessels, abdominal and pelvic organs, obstetric ultrasound, the eye, soft tissue, and the musculoskeletal system. The studies found in general either high sensitivity or high specificity for the particular test studied, and in some cases high total accuracy and superiority to other established diagnostic imaging modalities. PoCUS also showed faster time to diagnosis and change in management in some studies. CONCLUSION Our review shows that generalists can, given a certain level of pre-test probability, safely use PoCUS in a wide range of clinical settings to aid diagnosis and better the care of their patients.
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Affiliation(s)
- Bjarte Sorensen
- Hjelmeland General Practice Surgery, Prestagarden 13, 4130, Hjelmeland, Norway.
| | - Steinar Hunskaar
- Department of Global Public Health and Primary Care, University of Bergen, Bergen, Norway
- National Centre for Emergency Primary Health Care, NORCE Norwegian Research Centre AS, Bergen, Norway
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16
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Conlon TW, Nishisaki A, Singh Y, Bhombal S, De Luca D, Kessler DO, Su ER, Chen AE, Fraga MV. Moving Beyond the Stethoscope: Diagnostic Point-of-Care Ultrasound in Pediatric Practice. Pediatrics 2019; 144:peds.2019-1402. [PMID: 31481415 DOI: 10.1542/peds.2019-1402] [Citation(s) in RCA: 58] [Impact Index Per Article: 11.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/19/2019] [Indexed: 11/24/2022] Open
Abstract
Diagnostic point-of-care ultrasound (POCUS) is a growing field across all disciplines of pediatric practice. Machine accessibility and portability will only continue to grow, thus increasing exposure to this technology for both providers and patients. Individuals seeking training in POCUS should first identify their scope of practice to determine appropriate applications within their clinical setting, a few of which are discussed within this article. Efforts to build standardized POCUS infrastructure within specialties and institutions are ongoing with the goal of improving patient care and outcomes.
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Affiliation(s)
- Thomas W Conlon
- Departments of Anesthesiology and Critical Care Medicine and
| | - Akira Nishisaki
- Departments of Anesthesiology and Critical Care Medicine and
| | - Yogen Singh
- Cambridge University Hospitals National Health Service Foundation Trust, Cambridge, United Kingdom
| | - Shazia Bhombal
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Daniele De Luca
- Division of Pediatrics and Neonatal Critical Care, Hopital Antoine Béclère, University Hospitals of South Paris, AP-HP, Paris, France.,Physiopathology and Therapeutic Innovation Unit, Inserm U999, Université Paris-Saclay, Paris, France; and
| | - David O Kessler
- Department of Emergency Medicine, Vagelos College of Physicians and Surgeons, Columbia University, New York, New York
| | - Erik R Su
- Department of Pediatrics, Lucile Packard Children's Hospital Stanford, Palo Alto, California
| | - Aaron E Chen
- Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - María V Fraga
- Pediatrics, Children's Hospital of Philadelphia and Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
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17
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Abstract
BACKGROUND More than half of children evaluated as outpatients for abdominal pain are diagnosed with constipation. X-ray use in this scenario is variable: less than 5% in clinic settings, greater than 70% in emergency departments. X-rays increase misdiagnosis rate, remain costly, and involve radiation exposure. OBJECTIVES The aim of this study was to assess the use of plain radiographs by pediatric emergency medicine (PEM) providers in the diagnostic evaluation and management of pediatric constipation. METHODS A cross-sectional survey of PEM providers was performed. Survey participants were subscribers to the American Academy of Pediatrics Section on Emergency Medicine Listserv. To assess diagnostic and therapeutic approaches, participants were presented a case of pediatric constipation meeting Rome III clinical criteria. Participants also categorized frequency of x-ray use, reasons for obtaining, estimated diagnostic utility, and elements of institutional standard approach. Descriptive statistical analyses were performed. RESULTS Three hundred five of 1272 Listserv members (24%) responded. Ninety-nine percent elected to treat for constipation in a case meeting Rome III clinical criteria; one third (31%) would obtain plain radiographs for this same scenario. Plain radiographs were viewed as somewhat (59%) or minimally (29%) value-added in the evaluation of suspected pediatric constipation. Obtaining family buy-in (44%) was the most common reason for utilizing plain radiographs. Frequency of use varied across geographic regions and with participant and hospital characteristics. CONCLUSIONS This survey suggests that many PEM providers obtain radiographs to convince families of the diagnosis of constipation. This is not a viable management plan given the risks of radiation as well as costs. There remains room for improvement as we attempt to reduce use of radiation in the evaluation of common pediatric illnesses.
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18
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Hopkins A, Doniger SJ. Point-of-Care Ultrasound for the Pediatric Hospitalist's Practice. Hosp Pediatr 2019; 9:707-718. [PMID: 31405888 DOI: 10.1542/hpeds.2018-0118] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Point-of-care ultrasound (POCUS) has the potential to provide real-time valuable information that could alter diagnosis, treatment, and management practices in pediatric hospital medicine. We review the existing pediatric POCUS literature to identify potential clinical applications within the scope of pediatric hospital medicine. Diagnostic point-of-care applications most relevant to the pediatric hospitalist include lung ultrasound for pneumothorax, pleural effusion, pneumonia, and bronchiolitis; cardiac ultrasound for global cardiac function and hydration status; renal or bladder ultrasound for nephrolithiasis, hydronephrosis, and bladder volumes; soft tissue ultrasound for differentiating cellulitis from abscess; and procedural-guidance applications, including line placement, lumbar puncture, and abscess incision and drainage. We discuss POCUS applications with reviews of major pathologic findings, research gaps, the integration of POCUS into practice, and barriers to implementation.
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Affiliation(s)
- Akshata Hopkins
- Johns Hopkins All Children's Hospital, St. Petersburg, Florida; and
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19
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MOMENI M, MOMEN-GHARIBVAND M, KULOUEE N, JAVAHERIZADEH H. ULTRASONOGRAPHY IN DETERMINING THE RECTAL DIAMETER AND RECTAL WALL THICKNESS IN CHILDREN WITH AND WITHOUT CONSTIPATION: A CASE-CONTROL STUDY. ARQUIVOS DE GASTROENTEROLOGIA 2019; 56:84-87. [DOI: 10.1590/s0004-2803.201900000-19] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2018] [Accepted: 03/13/2019] [Indexed: 12/12/2022]
Abstract
ABSTRACT BACKGROUND: Ultrasonography has shown to be useful in the diagnosis of constipation. OBJECTIVE: The aim of this study was to compare the rectal diameter and rectal wall thickness in children with and without constipation. METHODS: Children with the diagnosis of constipation according to Rome III criteria were included in the study. The children underwent transabdominal sonography for the evaluation of rectal diameter and rectal wall thickness. Ultrasonography was performed with a full bladder. Children without constipation who underwent abdominal sonography were assigned to the control group. RESULTS: The rectal diameter was larger in children with constipation than in children without constipation (31.72±9.63 mm vs 19.85±4.37 mm; P=0.001). The rectal wall was thinner in children with constipation than in children without constipation (1.75±0.33 mm vs 1.90±0.22 mm; P=0.032). There was no significant difference between boys and girls with constipation in terms of rectal diameter (31.02±8.57 mm 32.77±11.35 mm; P=0.63). CONCLUSION: Transabdominal rectal diameter measurement may be useful in the diagnosis of constipation.
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20
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Sharma P, Al-Sani F, Saini S, Sao Pedro T, Wong P, Etoom Y. Point-of-Care Ultrasound in Pediatric Diagnostic Dilemmas: Two Atypical Presentations of Intussusception. Pediatr Emerg Care 2019; 35:72-74. [PMID: 30608331 DOI: 10.1097/pec.0000000000001712] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Diagnostic dilemmas are ubiquitous in pediatric emergency medicine because of the varied and often insidious presentations of many pediatric conditions. Point-of-care ultrasound (POCUS) in emergency departments is being used for some of these diagnostic challenges and can often provide rapid and valuable information to supplement a physician's clinical assessment. Intussusception is a pediatric condition that may be challenging to recognize because of its subtle and varied presenting symptoms. An unrecognized or delayed diagnosis of intussusception can be catastrophic, with complications including bowel obstruction, bowel perforation, and death. Here we present two challenging cases of intussusception, one due to its atypical age of presentation and the other due to its unique symptoms. These cases demonstrate the benefits of point-of-care ultrasound for diagnostically challenging cases in the emergency department.
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Affiliation(s)
| | - Faisal Al-Sani
- Department of Pediatrics, College of Medicine, University of Saskatchewan, Saskatoon, Saskatchewan
| | - Sidharth Saini
- Department of Radiology, Faculty of Medicine, University of Toronto
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21
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Trajanovska M, King SK, Gibb S, Goldfeld S. Children who soil: A review of the assessment and management of faecal incontinence. J Paediatr Child Health 2018; 54:1136-1141. [PMID: 30294989 DOI: 10.1111/jpc.14173] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 07/19/2018] [Indexed: 11/30/2022]
Abstract
Soiling is a common and distressing condition affecting children. In the vast majority of patients, it is associated with constipation. Most constipation is functional and is best thought of as difficulty achieving adequate bowel emptying. In a small minority of patients, there is no associated constipation, so-called non-retentive faecal incontinence. The aetiology of this latter condition in children remains unclear. The mainstay of management in all cases is a regular toileting programme, together with laxatives as required. This must be individualised considering the diagnosis, the age of the child and the psychosocial factors affecting the child and family. The diagnosis is made with a thorough history and examination, supplemented in some cases with targeted investigations. Engaging the child and family in a long-term treatment programme (at least 6 months to 2 years) is essential for treatment success. The following clinical practice guideline and algorithm for the assessment and management of children who soil represents consensus opinion using available evidence.
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Affiliation(s)
- Misel Trajanovska
- Centre for Community Department of Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Sebastian K King
- Department of Paediatric Surgery, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia
| | - Susan Gibb
- Department of Neurodevelopment and Disability, Royal Children's Hospital, Melbourne, Victoria, Australia.,Department of General Medicine, Royal Children's Hospital, Melbourne, Victoria, Australia.,Infection and Immunity, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Neurodevelopmental and Behavioural Paediatric Society of Australasia (https://nbpsa.org/)
| | - Sharon Goldfeld
- Centre for Community Department of Child Health, Royal Children's Hospital, Melbourne, Victoria, Australia.,Population Health, Murdoch Children's Research Institute, Melbourne, Victoria, Australia.,Department of Paediatrics, University of Melbourne, Melbourne, Victoria, Australia
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22
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Gonzalez LK, Yellin S, Arroyo AC. Point-of-Care Ultrasound in the Pediatric Emergency Department: Where We're at, Where We're Going. Adv Pediatr 2018; 65:121-142. [PMID: 30053920 DOI: 10.1016/j.yapd.2018.04.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Affiliation(s)
- Laura K Gonzalez
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, 4082 10th Avenue, Brooklyn, NY 11219, USA
| | - Sharon Yellin
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, New York Presbyterian Brooklyn Methodist Hospital, 506 6th Street, Brooklyn, NY 11215, USA
| | - Alexander C Arroyo
- Division of Pediatric Emergency Medicine, Department of Emergency Medicine, Maimonides Medical Center, 4082 10th Avenue, Brooklyn, NY 11219, USA.
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23
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Snelling PJ, Tessaro M. Paediatric emergency medicine point-of-care ultrasound: Fundamental or fad? Emerg Med Australas 2017; 29:486-489. [PMID: 28845599 DOI: 10.1111/1742-6723.12848] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Affiliation(s)
- Peter J Snelling
- Emergency Department, Lady Cilento Children's Hospital, Brisbane, Queensland, Australia.,Department of Paediatrics, Greenslopes Private Hospital, Brisbane, Queensland, Australia.,School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark Tessaro
- Emergency Department, Hospital for Sick Children, Toronto, Ontario, Canada.,Department of Paediatrics, University of Toronto, Toronto, Ontario, Canada
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