1
|
Vega-Fernandez P, Rogers K, Sproles A, Thornton S, Huggins J, Lovell DJ, Cassedy A, Meyers AB, Ting TV. Diagnostic Accuracy Study of the Pediatric-Specific Ultrasound Scoring System for the Knee Joint in Children With Juvenile Idiopathic Arthritis. Arthritis Care Res (Hoboken) 2024; 76:251-258. [PMID: 37587869 PMCID: PMC10841426 DOI: 10.1002/acr.25218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 06/22/2023] [Accepted: 08/10/2023] [Indexed: 08/18/2023]
Abstract
OBJECTIVE We undertook this study to validate the Pediatric Arthritis Ultrasound Scoring System for the knee joint (PAUSS-knee) in children with juvenile idiopathic arthritis (JIA). METHODS Children with JIA were enrolled to prospectively receive a musculoskeletal ultrasound (MSUS) examination of the knee and a physical examination to determine presence/absence of clinical arthritis. MSUS images were scored using the PAUSS-knee, a semiquantitative MSUS scoring system (0-3, normal to severe) for B-mode and power Doppler mode. In addition to MSUS, a subset of participants also received magnetic resonance imaging (MRI) of the knee, which was scored according to the combined Juvenile Arthritis MRI Scoring (JAMRIS) system. Spearman's correlations (rs ) were used to calculate associations between variables. Test characteristics of the PAUSS-knee were calculated with MRI as the reference standard. Inflammatory biomarkers were assessed in synovial fluid from involved knees. RESULTS Eighty children with JIA contributed 112 MSUSs and 25 MRIs of the knee. Of the knees, 41% (n = 46) had clinical evidence of arthritis. The B-mode PAUSS-knee score moderately correlated with clinically determined arthritis (rs = 0.54, P < 0.001) and strongly correlated with the JAMRIS score (rs = 0.75, P < 0.001). Compared with MRI, the area under the curve for the B-mode PAUSS-knee was 0.92. For a cutoff of >1, the B-mode PAUSS-knee had a sensitivity of 83% and specificity of 82%. Biomarker analysis indicates that interleukin-2R levels correlate with PAUSS score. CONCLUSION Our data indicate that the PAUSS-knee has excellent accuracy for the diagnosis of arthritis when compared with MRI. The PAUSS-knee has the potential to effectively inform JIA medical decision-making in real time.
Collapse
Affiliation(s)
- Patricia Vega-Fernandez
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Kelly Rogers
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Alyssa Sproles
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Sherry Thornton
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Jennifer Huggins
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Daniel J. Lovell
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| | - Amy Cassedy
- Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Division of Biostatistics and Epidemiology, Cincinnati, OH, USA
| | - Arthur B Meyers
- Department of Radiology, University of Cincinnati, Cincinnati Children’s Hospital Medical Center, Division of Radiology, Cincinnati, OH, USA
| | - Tracy V Ting
- Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children’s Hospital Medical Center, Cincinnati, OH, USA
| |
Collapse
|
2
|
Esteban Y, Rodriguez-Smith J, Tominna M, Cassedy A, Meyers AB, Henrickson M, Ting TV, Vega-Fernandez P. Dissemination of a Pediatric Musculoskeletal POCUS Scoring System via Virtual Education: A Proof-of-Concept Study. POCUS JOURNAL 2023; 8:146-152. [PMID: 38099160 PMCID: PMC10721286 DOI: 10.24908/pocus.v8i2.16229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/17/2023]
Abstract
Point of care pediatric musculoskeletal POCUS scanning and scoring protocols for childhood arthritis have emerged in recent years. However, pediatric musculoskeletal POCUS curricula in rheumatology fellowship programs are limited due to availability of trained faculty and resources. This proof-of-concept study investigated the effectiveness of educational methods for a pediatric musculoskeletal POCUS scoring protocol among fellows and physicians of differing subspecialties. Educational methods assessed included recorded videos and virtual review sessions. Effectiveness was assessed by calculating interrater reliability for the musculoskeletal POCUS scoring systems using the intra-class correlation coefficient (ICC). Following training sessions, participants then underwent scoring exercise(s) until the goal of an excellent ICC ≥ 0.75 was reached. Four participants completed two rounds of virtual education, review, and scoring sessions. Excellent interrater reliability was achieved for most views. This proof-of-concept study demonstrated virtual education covering advanced concepts of pediatric musculoskeletal POCUS provides a knowledge base for physicians from different subspecialties and various experience.
Collapse
Affiliation(s)
- Ysabella Esteban
- Division of Rheumatology, Nationwide Children's HospitalColumbus, OHUSA
| | - Jackeline Rodriguez-Smith
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | | | - Amy Cassedy
- Department of Pediatrics, Division of Biostatistics and Epidemiology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Arthur B Meyers
- Department of Radiology, Division of Radiology and Medical Imaging, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Michael Henrickson
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Tracy V Ting
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| | - Patricia Vega-Fernandez
- Department of Pediatrics, Division of Rheumatology, University of Cincinnati, Cincinnati Children's Hospital Medical CenterCincinnati, OHUSA
| |
Collapse
|