Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

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Abstract

The utility of point-of-care ultrasound is well supported by the medical literature. Consequently, pediatric emergency medicine providers have embraced this technology in everyday practice. Recently, the American Academy of Pediatrics published a policy statement endorsing the use of point-of-care ultrasound by pediatric emergency medicine providers. To date, there is no standard guideline for the practice of point-of-care ultrasound for this specialty. This document serves as an initial step in the detailed “how to” and description of individual point-of-care ultrasound examinations. Pediatric emergency medicine providers should refer to this paper as reference for published research, objectives for learners, and standardized reporting guidelines.

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Most cited references 406

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To Err Is Human : Building a Safer Health System

(2000)

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Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians

John D Mathews, Anna V Forsythe, Zoe Brady … (2013)

Objective To assess the cancer risk in children and adolescents following exposure to low dose ionising radiation from diagnostic computed tomography (CT) scans. Design Population based, cohort, data linkage study in Australia. Cohort members 10.9 million people identified from Australian Medicare records, aged 0-19 years on 1 January 1985 or born between 1 January 1985 and 31 December 2005; all exposures to CT scans funded by Medicare during 1985-2005 were identified for this cohort. Cancers diagnosed in cohort members up to 31 December 2007 were obtained through linkage to national cancer records. Main outcome Cancer incidence rates in individuals exposed to a CT scan more than one year before any cancer diagnosis, compared with cancer incidence rates in unexposed individuals. Results 60 674 cancers were recorded, including 3150 in 680 211 people exposed to a CT scan at least one year before any cancer diagnosis. The mean duration of follow-up after exposure was 9.5 years. Overall cancer incidence was 24% greater for exposed than for unexposed people, after accounting for age, sex, and year of birth (incidence rate ratio (IRR) 1.24 (95% confidence interval 1.20 to 1.29); P<0.001). We saw a dose-response relation, and the IRR increased by 0.16 (0.13 to 0.19) for each additional CT scan. The IRR was greater after exposure at younger ages (P<0.001 for trend). At 1-4, 5-9, 10-14, and 15 or more years since first exposure, IRRs were 1.35 (1.25 to 1.45), 1.25 (1.17 to 1.34), 1.14 (1.06 to 1.22), and 1.24 (1.14 to 1.34), respectively. The IRR increased significantly for many types of solid cancer (digestive organs, melanoma, soft tissue, female genital, urinary tract, brain, and thyroid); leukaemia, myelodysplasia, and some other lymphoid cancers. There was an excess of 608 cancers in people exposed to CT scans (147 brain, 356 other solid, 48 leukaemia or myelodysplasia, and 57 other lymphoid). The absolute excess incidence rate for all cancers combined was 9.38 per 100 000 person years at risk, as of 31 December 2007. The average effective radiation dose per scan was estimated as 4.5 mSv. Conclusions The increased incidence of cancer after CT scan exposure in this cohort was mostly due to irradiation. Because the cancer excess was still continuing at the end of follow-up, the eventual lifetime risk from CT scans cannot yet be determined. Radiation doses from contemporary CT scans are likely to be lower than those in 1985-2005, but some increase in cancer risk is still likely from current scans. Future CT scans should be limited to situations where there is a definite clinical indication, with every scan optimised to provide a diagnostic CT image at the lowest possible radiation dose.

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Point-of-care ultrasonography.

Christopher L. Moore, Joshua A. Copel (2011)

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Contributors

Jennifer R. Marin: 412-692-7692 , jrmmarin@yahoo.com

Alyssa M. Abo: alyssa.abo@gmail.com

Alexander C. Arroyo: aarroyo@maimonidesmed.org

Stephanie J. Doniger: sjdoniger@gmail.com

Jason W. Fischer: jason.fischer@sickkids.ca

Rachel Rempell: rachel.rempell@childrens.harvard.edu

Brandi Gary: garybrmg@gmail.com

James F. Holmes: jfholmes@ucdavis.edu

David O. Kessler: drkessler@gmail.com

Samuel H. F. Lam: emedicine@yahoo.com

Marla C. Levine: marla.levine@gmail.com

Jason A. Levy: jason.levy@childrens.harvard.edu

Alice Murray: alicefmurray@gmail.com

Lorraine Ng: lorraine.ng@gmail.com

Vicki E. Noble: vnoblest01@gmail.com

Daniela Ramirez-Schrempp: ramirezdaniela@yahoo.com

David C. Riley: dr499@columbia.edu

Turandot Saul: turan@joshsaul.com

Vaishali Shah: vaishalishah13@gmail.com

Adam B. Sivitz: asivitz@gmail.com

Ee Tein Tay: eetaymd@gmail.com

David Teng: dnateng@yahoo.com

Lindsey Chaudoin: lindseytilt@gmail.com

James W. Tsung: jtsung@gmail.com

Rebecca L. Vieira: rebecca.vieira@childrens.harvard.edu

Yaffa M. Vitberg: yaffa.vitberg@gmail.com

Resa E. Lewiss: resaelewiss@gmail.com

Journal

Journal ID (nlm-ta): Crit Ultrasound J

Journal ID (iso-abbrev): Crit Ultrasound J

Title: Critical Ultrasound Journal

Publisher: Springer Milan (Milan )

ISSN (Print): 2036-3176

ISSN (Electronic): 2036-7902

Publication date (Electronic): 3 November 2016

Publication date PMC-release: 3 November 2016

Publication date Collection: 2016

Volume: 8

Electronic Location Identifier: 16

Affiliations

[1 ]Children’s Hospital of Pittsburgh, 4401 Penn Ave, AOB Suite 2400, Pittsburgh, PA 15224 USA

[2 ]Children’s National Medical Center, Washington DC, USA

[3 ]Maimonides Medical Center, Brooklyn, NY USA

[4 ]New York Methodist Hospital, Brooklyn, NY USA

[5 ]Hospital for Sick Children, Toronto, Ontario Canada

[6 ]Boston Children’s Hospital, Boston, MA USA

[7 ]Queens Medical Center, Honolulu, HI USA

[8 ]University of California-Davis, Sacramento, CA USA

[9 ]Morgan Stanley Children’s Hospital, New York, NY USA

[10 ]University of California-San Diego, San Diego, CA USA

[11 ]Dell Children’s Medical Center, Austin, USA

[12 ]Boston Medical Center, Boston, MA USA

[13 ]Massachusetts General Hospital, Boston, MA USA

[14 ]Boston University Medical Center, Boston, NY USA

[15 ]Columbia University Medical Center, New York, NY USA

[16 ]St. Lukes-Roosevelt Hospital, New York, NY USA

[17 ]Montefiore Medical Center, Bronx, NY USA

[18 ]Newark Beth Israel Medical Center, Newark, NJ USA

[19 ]Mount Sinai Hospital, New York, NY USA

[20 ]Cohen Children’s Medical Center, New Hyde Park, USA

[21 ]Weill Cornell Medical Center, New York, NY USA

[22 ]University of Colorado, Aurora, CO USA

Article

Publisher ID: 49

DOI: 10.1186/s13089-016-0049-5

PMC ID: 5095098

PubMed ID: 27812885

SO-VID: df5bb17a-0d7a-4c78-8019-9763cee5a61c

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

History

Date received : 29 March 2016

Date accepted : 1 September 2016

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ScienceOpen disciplines: Radiology & Imaging

Keywords: pediatric emergency medicine,point-of-care ultrasound,diagnostic,procedures

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ScienceOpen disciplines: Radiology & Imaging

Keywords: pediatric emergency medicine, point-of-care ultrasound, diagnostic, procedures

Pediatric emergency medicine point-of-care ultrasound: summary of the evidence

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Most cited references 406

To Err Is Human : Building a Safer Health System

Cancer risk in 680 000 people exposed to computed tomography scans in childhood or adolescence: data linkage study of 11 million Australians

Point-of-care ultrasonography.

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