point of care ultrasonography (pocus) in pediatric...

REFERENCES

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2. Kolb, A; Schweiger, N; Mailath-Pokorny, M (2016) Low incidence of early developmental dysplasia of the hip in universal ultrasonographic screening of newborns: analysis and evaluation of risk factors. International Orthopaedics

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0BJECTIVES

1. To describe the possibilities and advantages of the use of the ultrasonography in patients of pediatric rehabilitation

2. To explain the pathology in which we use the ultrasonography in the normal clinical setting

POINT OF CARE ULTRASONOGRAPHY (POCUS) IN PEDIATRIC

REHABILITATION Juan Andrés Conejero Casares, Belen Romero Romero, Manuel Rodriguez-Piñero Duran, Paola Díaz Borrego

Physical Medicine and Rehabilitation Physician, Pediatric Rehabilitation Unit Virgen Macarena University Hospital,

Rehabilitación Department, Seville. Spain

PATIENTS AND METHODS

POCUS is a way of ultrasonography use that gather the following rules:

1. Done immediately and beside the patient.

2. Clinician can see dynamic ultrasonographic image at real-time.

3. It allows correlate the findings with signs and symptom at the same moment.

4. Easily repeatable if clinical conditions change (monitoring).

It has clear advantages, improving clinical exam and avoiding diagnostical delay.

Despite of the most recent searching in PubMed can show as far as 6410 articles, only 7 are related to pediatric rehabilitation, one of them about quadriceps muscle loss in

seriously ill children.

RESULTS

In Pediatric Rehabilitation it has a triple application.

1. Procedure guide: Botulinum toxin echo guided injection in muscle and in salivary

glands, transitorily or definitive nerve blocks with radiofrequency or arthrocentesis.

2. Diagnosis: Transient synovitis of the hip, Juvenile idiopathic arthritis, hemophilic

arthropathy, muscular congenital torticollis, muscle and tendinous injuries, femoral head

cover in cerebral palsy hips, oropharyngeal dysphagia evaluation, state of the muscle in

cerebral palsy ( Figure 1) and myopathies

3. Screening: hip development dysplasia in newborn (Figure 2): controversial between

selective and universal ultrasonographic screening (only in Germany, Austria, Slovenia

and Switzerland). We show the results of universal ultrasonographic sreening in

prematures and infants under 3 months accomplished in our service (Table I)

CONCLUSION

POCUS allows a faster and accurate approach of the relevant pathology in pediatric

rehabilitation, improving and can modify notably the current clinical practice

Type of Graf Prematures (n 93) Infants (n 189)

Ia- Ib (Normal) 89.94% L 76.7% R 79.4%

IIa (Inmature) 12.90% L 17.5% R 16.4%

DDH (IIc) 1.07% L 3.2% R 1.6%

DDH (III) 1.07% L 0.5% R 1.6%

DDH (IV) L 1.1 %

Figure 2

A. Normal hip ( Graf Ia) B. Developmental dysplasia of the hip (Graf IIIb)

Figure 1

A. Medial gastrocnemius in hemiplegic cerebral palsy: paretic limb (Heckmatt IV) B.

Normal limb (Hecmatt II)

A

A B

A B

Table I

Results of universal ultrasonographic hip screening in our clinical practice

INTRODUCTION

Nowadays, ultrasonography is a common tool used in clinical environments regardless of radiology departments. The term POCUS begins its use with Moore and Copel article

in 2011. From then, its growth has been exponential, being part of the pre and post-grade training in (different) Medicine Schools around the world.