Purpose Hip ultrasound is becoming an increasingly popular diagnostic tool in orthopaedics as it evaluates bone and soft tissue without exposing patients to radiation, is non-invasive, and is widely accessible and less expensive. However, despite the multi-fold use of the hip ultrasound, most orthopaedic surgery programs do not have formal training courses in ultrasound for residents. Thus, reading ultrasounds to accurately diagnose pathologies is a skill many residents and, even attending physicians, lack. The purpose of this study was to determine how accurate resident, fellow, and attending physicians are at diagnosing common pediatric hip conditions on ultrasound compared to more conventional imaging modalities, X-Ray and MRI. Methods Orthopaedic residents, pediatric orthopaedic attendings, radiology residents and radiology attendings were recruited to participate in an electronic survey (REDCap, Vanderbilt University) distributed via email. The survey consisted of demographic questions regarding level of training and experience with ultrasound followed by 30 pediatric images for which the participant was asked to select the hip pathology indicated. Possible diagnoses included Developmental Dysplasia of the Hip, Hip Effusion, Slipped Capital Femoral Epiphysis, Legg-Calvé-Perthes disease or normal. Multivariable statistic models were used to analyze the data. Results Fifty-one respondents participated in the survey that demonstrated a significant difference between correctly diagnosing a pathology from an ultrasound image compared to that from X-Ray radiographs or MRI imaging modalities (p-value = 0.05). Among the 51 participants. 28 were residents, 2 were fellows, and 21 were attendings. Physician status was associated with an improved score given that attendings scored 15 points higher than residents (95% CI: 10 – 21, p<0.001). Thirty-eight (75%) of the respondents were orthopaedic surgeons while 13 (25%) were radiologists. On average, respondents correctly diagnosed 78% (SD: 12) of the 30 cases despite only 13 (25%) of the respondents have completed a formal ultrasound training course. Of the 8 ultrasound images included in the survey, 74% of responses correctly identified the pathologies displayed. Conclusion Physician trainees are less accurate at diagnosing hip pathologies compared to attendings of the same specialties. Ultrasound images were found to result in less accurate diagnosis (p -value=0.05) when compared to X-Ray radiographs or MRI images. Differences in diagnosing accuracy using ultrasound imaging demonstrates an indication to integrate more formal ultrasound training for both resident and attending level physicians. Future studies should analyze and quantify improvement in success rates of diagnosis after completion of formal ultrasound training programs.
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Section on Orthopaedics Program: Day 1|
July 01 2020
Accuracy of Diagnosing Pediatric Hip Conditions on Ultrasound
Joshua M. Abzug, MD;
Joshua M. Abzug, MD
University of Maryland School of Medicine, Baltimore, MD
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Aditya Muralidharan, BS;
Aditya Muralidharan, BS
University of Maryland School of Medicine, Baltimore, MD
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Alexandria L. Case, BSE;
Alexandria L. Case, BSE
University of Maryland School of Medicine, Baltimore, MD
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Danielle A. Hogarth, BS;
Danielle A. Hogarth, BS
University of Maryland School of Medicine, Baltimore, MD
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Nathan O'Hara, MHA
Nathan O'Hara, MHA
University of Maryland School of Medicine, Baltimore, MD
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Pediatrics (2020) 146 (1_MeetingAbstract): 412.
Citation
Joshua M. Abzug, Aditya Muralidharan, Alexandria L. Case, Danielle A. Hogarth, Nathan O'Hara; Accuracy of Diagnosing Pediatric Hip Conditions on Ultrasound. Pediatrics July 2020; 146 (1_MeetingAbstract): 412. 10.1542/peds.146.1MA5.412a
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