Keywords
1. POCUS Pediatric Intussusception
2. Point-of-Care Ultrasound Child Diagnosis
3. Emergency Medicine POCUS Utility
4. Pediatric Abdominal Pain Diagnosis
5. Intussusception Rapid Diagnostic Approaches
Emergency medical teams at the West Virginia University School of Medicine have successfully leveraged Point-of-Care Ultrasound (POCUS) to confirm a diagnosis of pediatric intussusception swiftly, potentially setting a new standard for immediate and accurate in-room diagnosis of this condition. The findings of this pivotal use of POCUS were detailed in an article titled “Definitive Diagnosis before Leaving the Room: POCUS for Pediatric Intussusception” in “The Journal of Emergency Medicine” dated August 2019, DOI: 10.1016/j.jemermed.2019.03.040, underlining the practical significance of this method in clinical settings where time and accuracy are paramount.
Intussusception is a serious and potentially life-threatening condition that causes one segment of the bowel to telescope into another. It leads to blocked blood flow and can result in a perforation of the bowel. The primary symptom is intermittent abdominal pain, often causing distress and can be accompanied by other clinical signs. Although intussusception is relatively rare, it is one of the leading causes of abdominal emergencies in children, predominantly affecting those between the ages of six months and three years.
Traditionally, diagnosing intussusception involves clinical examination, a series of tests, and imaging studies including radiography, computed tomography (CT), or an ultrasound scan. However, the time taken from symptom onset to diagnosis is critical in preventing significant morbidity or mortality. Therefore, swift and decisive diagnostic tools are crucial. This is where POCUS makes a monumental difference by significantly reducing the time to diagnosis.
Dr. Melinda J. Sharon and her colleagues from the Department of Emergency Medicine have shown with the case highlighted in “The Journal of Emergency Medicine” that POCUS provides immediate visual confirmation of intussusception. Due to its real-time imaging capability, it enables clinicians to observe the characteristic “target sign” on ultrasound right at the patient’s bedside. Consequently, clinicians can initiate urgent treatment without delay, sometimes even before leaving the room.
The American College of Emergency Physicians (ACEP) endorses POCUS as a standard tool in the assessment of pediatric emergency care. This case from the West Virginia University School of Medicine vividly demonstrates the practical implementation of ACEP policy, showcasing the pivotal role POCUS can play in the management of pediatric emergencies.
The Significance of POCUS in Pediatric Emergency Medicine
POCUS is non-invasive, readily accessible, and avoids the radiation risks associated with CT scans. It offers an instant visualization of internal organs, vessels, and soft tissues, which is highly beneficial in time-sensitive situations where young patients are involved. The research team, including Drs. Bradley End, Scott Findley, Clara Kraft, and Joseph J. Minardi, emphasizes the need for emergency medicine physicians to be proficient in the use of POCUS. Their findings underscore that in pediatric emergencies, a rapid and accurate diagnosis is pivotal for a positive patient outcome.
For the study case reported, a preschool-aged female child presented to the emergency department with abdominal pain – a typical presentation for intussusception. The swift utilization of POCUS by the attending physicians allowed for an immediate diagnosis, which facilitated timely intervention. The child’s care was expediated by avoiding the delays normally associated with awaiting results from more conventional imaging modalities.
The Implications for Future Emergency Medical Practice
This groundbreaking use of POCUS could drive improvements in the standard of care provided in emergency departments worldwide. Immediate diagnosis and intervention become even more crucial in rural or underserved areas, where access to comprehensive radiology services may be limited. POCUS can bridge this gap by enabling accurate diagnoses on-site, thus potentially saving lives.
The case reported potentially marks a turning point in pediatric emergency medicine, heralding a future where POCUS could become the first-line diagnostic tool in suspected intussusception cases. Its adaptability, ease of use, and the accuracy provided may result in it being adopted more widely in emergency settings and beyond.
Considerations and Future Directions
While the potential of POCUS is clear, there remains a need for widespread training and education in its use to ensure all physicians can leverage its capabilities fully. Furthermore, there is a need to establish standardized protocols for its use in specific pediatric emergencies like intussusception. The establishment of these guidelines will contribute to the consistency and reliability of diagnoses across various healthcare settings.
Conclusion
The incorporation of POCUS into routine emergency medicine practice represents a profound shift toward improved patient outcomes in cases of pediatric intussusception. This case study by the team at the West Virginia University School of Medicine serves as a benchmark for the successful application of bedside ultrasound in diagnosing acute abdominal conditions in children. As POCUS continues to evolve with technological advancements, its integration into the diagnostic process is likely to become increasingly indispensable.
References
1. Sharon, M. J., End, B., Findley, S., Kraft, C., Minardi, J. J. (2019). Definitive Diagnosis before Leaving the Room: POCUS for Pediatric Intussusception. The Journal of Emergency Medicine, 57(2), 247-248. doi: 10.1016/j.jemermed.2019.03.040.
2. Marin, J. R., Abo, A. M., Arroyo, A. C., Doniger, S. J., Fischer, J. W., Rempell, R., … & Raio, C. C. (2016). Pediatric emergency medicine point-of-care ultrasound: summary of the evidence. Critical Ultrasound Journal, 8(1), 16. doi: 10.1186/s13089-016-0049-5.
3. American College of Emergency Physicians. (2016). ACEP Policy Statement – Ultrasound Guidelines: Emergency, Point-of-Care, and Clinical Ultrasound Guidelines in Medicine. Retrieved from https://www.acep.org/patient-care/policy-statements/ultrasound-guidelines-emergency-point-of–care-and-clinical-ultrasound-guidelines-in-medicine/.
4. Riera, A., & Hsiao, A. L. (2013). Diagnosis and management of intestinal intussusception in pediatric patients. Pediatric emergency care, 29(4), 520-526. doi: 10.1097/PEC.0b013e31828a2082.
5. Menaker, J., Blumberg, S., Wisner, D. H., Dayan, P. S., Tunik, M., Garcia, M., & Singh, T. (2016). Use of the focused assessment with sonography for trauma (FAST) examination and its impact on abdominal computed tomography use in hemodynamically stable children with blunt torso trauma. JAMA pediatrics, 170(9), e160563. doi: 10.1001/jamapediatrics.2016.0563.