P2B016: Use of Pocket-sized Ultrasound (PsUS) for the Assessment of the Pediatric Elbow: A Feasibility Study

Background: Pocket-sized ultrasound (PsUS) is a novel area of point-of-care ultrasonography and has the potential to be a useful tool in evaluating pediatric elbow injuries in resource-limited settings. Previous research has evaluated hospital grade ultrasound devices in the evaluation of elbow injuries in children but no studies exist that have used PsUS to evaluate these kinds of pediatric injuries. In order to prepare for a larger study, we conducted a feasibility study to train pediatric emergency medicine (PEM) physicians to perform a standardized elbow exam protocol using a PsUS device. Our main objective was to determine the feasibility and efficacy of a brief structured training curriculum to teach PEM physicians, who were previously novice to elbow ultrasonography, to perform an adequate pediatric PsUS elbow exam. Our secondary objective was to evaluate the feasibility of completing the study’s PsUS elbow exam protocol in pediatric patients in a busy emergency department (ED).

Methods: Eight PEM physicians including attendings and fellows completed a curriculum composed of virtual and in-person didactic teachings, followed by hands-on workshops. Each provider was then required to complete 3 elbow exams on patients between the ages of 1-16 years old in a pediatric ED with study assistance available. The elbow exam protocol consisted of 10 standard views which was recorded as videos and reviewed by experienced study staff for adequate ultrasound quality (Fig. 1). Exams were evaluated based on if all necessary views were obtained with key landmarks included, the overall quality of images, and the interpretability of images.

Results: Twenty-one pediatric patients tolerated the exam with 42 elbow exams completed. Six out the 8 providers completed all 3 feasibility exams during the duration of the feasibility study. Only 1 provider needed to complete remediation on exams after initial feasibility training and exams. A total of 404 elbow videos were obtained of the standardized views and there were only 3 missing views from all of the exams completed. The quality of the images were graded as great (269/404, 66%), good (117/404, 29%), blurry/poor (15/404, 4%), unable to interpret (6/404, 1%) (Fig. 2). Adequate ultrasound image quality was considered videos that were of “Great” or “Good” quality, which resulted in 94% of images being graded as adequate.

Conclusion: This study demonstrates PEM physicians can readily achieve competence in pediatric PsUS elbow exams and the majority can obtain adequate, interpretable images with key landmarks after a brief structured training curriculum. The results of this study also show this standardized PsUS elbow exam can easily be tolerated by pediatric patients. Both the PsUS training curriculum and the elbow exam protocol developed in study are feasible as well as effective in teaching novice users and should be considered for use in future studies.