<< Diagnostic Emergency Ultrasound: Assessment Techniques In The Pediatric Patient


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Evidence-based medicine requires a critical appraisal of the literature based upon study methodology and number of subjects. Not all references are equally robust. The findings of a large, prospective, randomized, and blinded trial should carry more weight than a case report.

To help the reader judge the strength of each reference, pertinent information about the study, such as the type of study and the number of patients in the study will be included in bold type following the references, where available. The most informative references cited in this paper, as determined by the author, will be noted by an asterisk (*) next to the number of the reference.

  1. Accreditation Council for Graduate Medical Education. ACGME Program Requirements for Graduate Medical Education in Emergency Medicine. 2013. Available at: http://www.acgme.org/acgmeweb/portals/0/pfassets/2013-pr-faq-pif/110_emergency_medicine_07012013.pdf. Accessed September 12, 2014. (Website)
  2. Holmes JF, Gladman A, Chang CH. Performance of abdominal ultrasonography in pediatric blunt trauma patients: a meta-analysis. J Pediatr Surg. 2007;42(9):1588-1594. (Meta-analysis; 25 studies)
  3. Lee BC, Ormsby EL, McGahan JP, et al. The utility of sonography for the triage of blunt abdominal trauma patients to exploratory laparotomy. AJR Am J Roentgenol. 2007;188(2):415-421. (Retrospective study; 4029 patients)
  4. Williams SR, Perera P, Gharahbaghian L. The FAST and E-FAST in 2013: trauma ultrasonography: overview, practical techniques, controversies, and new frontiers. Crit Care Clin. 2014;30(1):119-150. (Review)
  5. Jehle D, Guarino J, Karamanoukian H. Emergency department ultrasound in the evaluation of blunt abdominal trauma. Am J Emerg Med. 1993;11(4):342-346. (Retrospective study; 44 patients)
  6. Rothlin MA, Naf R, Amgwerd M, et al. Ultrasound in blunt abdominal and thoracic trauma. J Trauma. 1993;34(4):488-495. (Prospective observational study; 312 patients)
  7. Rozycki GS, Ochsner MG, Schmidt JA, et al. A prospective study of surgeon-performed ultrasound as the primary adjuvant modality for injured patient assessment. J Trauma. 1995;39(3):492-498. (Prospective observational study; 371 patients)
  8. Charles M. UNSCEAR report 2000: sources and effects of ionizing radiation. United Nations Scientific Comittee on the Effects of Atomic Radiation. J Radiol Prot. 2001;21(1):83-86. (General report)
  9. National Research Council Committee to Assess Health Risks from Exposure to Low Levels of Ionizing Radiation, Board on Radiation Effects Research, Division on Earth and Life Studies. Health Risks from Exposure to Low Levels of Ionizing Radiation: BEIR VII Phase 2. The National Academies Press; Washington DC: 2006. (Epidemiological report)
  10. Preston DL, Ron E, Tokuoka S, et al. Solid cancer incidence in atomic bomb survivors: 1958-1998. Radiat Res. 2007;168(1):1- 64. (Prospective cohort study; 105,427 patients)
  11. Smith-Bindman R. Environmental causes of breast cancer and radiation from medical imaging: findings from the Institute of Medicine report. Arch Intern Med. 2012;172(13):1023- 1027. (Systematic review)
  12. * Pearce MS, Salotti JA, Little MP, et al. Radiation exposure from CT scans in childhood and subsequent risk of leukaemia and brain tumours: a retrospective cohort study. Lancet. 2012;380(9840):499-505. (Retrospective cohort study; 179,000 patients)
  13. Brenner DJ, Hall EJ. Computed tomography--an increasing source of radiation exposure. N Engl J Med. 2007;357(22):2277-2284. (Review)
  14. * Fox JC, Boysen M, Gharahbaghian L, et al. Test characteristics of focused assessment of sonography for trauma for clinically significant abdominal free fluid in pediatric blunt abdominal trauma. Acad Emerg Med. 2011;18(5):477-482. (Prospective cohort study; 357 patients)
  15. Nelson BP, Chason K. Use of ultrasound by emergency medical services: a review. Int J Emerg Med. 2008;1(4):253-259. (Review)
  16. Taylor J, McLaughlin K, McRae A, et al. Use of prehospital ultrasound in North America: a survey of emergency medical services medical directors. BMC Emerg Med. 2014;14:6. (Cross-sectional survey; 255 responses)
  17. Rudolph SS, Sorensen MK, Svane C, et al. Effect of prehospital ultrasound on clinical outcomes of non-trauma patients--a systematic review. Resuscitation. 2014;85(1):21-30. (Systematic review; 10 studies)
  18. Jorgensen H, Jensen CH, Dirks J. Does prehospital ultrasound improve treatment of the trauma patient? A systematic review. Eur J Emerg Med. 2010;17(5):249-253. (Systematic review; 14 studies)
  19. Walcher F, Weinlich M, Conrad G, et al. Prehospital ultrasound imaging improves management of abdominal trauma. Br J Surg. 2006;93(2):238-242. (Prospective cohort study; 202 patients)
  20. Kim CH, Shin SD, Song KJ, et al. Diagnostic accuracy of focused assessment with sonography for trauma (FAST) examinations performed by emergency medical technicians. Prehosp Emerg Care. 2012;16(3):400-406. (Prospective cohort study; 240 patients)
  21. Lyon M, Walton P, Bhalla V, et al. Ultrasound detection of the sliding lung sign by prehospital critical care providers. Am J Emerg Med. 2012;30(3):485-488. (Randomized observational trial; 48 trials)
  22. Shah S, Dalal A, Smith RM, et al. Impact of portable ultrasound in trauma care after the Haitian earthquake of 2010. Am J Emerg Med. 2010;28(8):970-971. (Review)
  23. Sztajnkrycer MD, Baez AA, Luke A. FAST ultrasound as an adjunct to triage using the START mass casualty triage system: a preliminary descriptive system. Prehosp Emerg Care. 2006;10(1):96-102. (Retrospective chart review; 359 patients)
  24. Shorter M, Macias DJ. Portable handheld ultrasound in austere environments: use in the Haiti disaster. Prehosp Disaster Med. 2012;27(2):172-177. (Retrospective cohort study; 51 patients)
  25. Hu H, He Y, Zhang S, et al. Streamlined focused assessment with sonography for mass casualty prehospital triage of blunt torso trauma patients. Am J Emerg Med. 2014;32(7):803- 806. (Retrospective case review; 45 patients)
  26. Beck-Razi N, Fischer D, Michaelson M, et al. The utility of focused assessment with sonography for trauma as a triage tool in multiple-casualty incidents during the second Lebanon war. J Ultrasound Med. 2007;26(9):1149-1156. (Retrospective chart review; 849 patients)
  27. Breitkreutz R, Price S, Steiger HV, et al. Focused echocardiographic evaluation in life support and peri-resuscitation of emergency patients: a prospective trial. Resuscitation. 2010;81(11):1527-1533. (Prospective observational study; 204 patients)
  28. Prosen G, Krizmaric M, Zavrsnik J, et al. Impact of modified treatment in echocardiographically confirmed pseudo-pulseless electrical activity in out-of-hospital cardiac arrest patients with constant end-tidal carbon dioxide pressure during compression pauses. J Int Med Res. 2010;38(4):1458- 1467. (Prospective cohort study; 16 patients)
  29. Brun PM, Bessereau J, Cazes N, et al. Lung ultrasound associated to capnography to verify correct endotracheal tube positioning in prehospital. Am J Emerg Med. 2012;30(9):2080. (Case report)
  30. Neesse A, Jerrentrup A, Hoffmann S, et al. Prehospital chest emergency sonography trial in Germany: a prospective study. Eur J Emerg Med. 2012;19(3):161-166. (Prospective cohort study; 62 patients)
  31. Cheitlin MD, Armstrong WF, Aurigemma GP, et al. ACC/ AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article. A report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines (ACC/AHA/ ASE Committee to Update the 1997 Guidelines for the Clinical Application of Echocardiography). Circulation. 2003;108(9):1146-1162. (Guidelines)
  32. Brown JM. Use of echocardiography for hemodynamic monitoring. Crit Care Med. 2002;30(6):1361-1364. (Review)
  33. Klugman D, Berger JT. Echocardiography as a hemodynamic monitor in critically ill children. Pediatr Crit Care Med. 2011;12(4 Suppl):S50-S54. (Review)
  34. * Via G, Hussain A, Wells M, et al. International evidence-based recommendations for focused cardiac ultrasound. J Am Soc Echocardiogr. 2014;27(7):683. (Guidelines)
  35. Gallagher RA, Levy JA. Advances in point-of-care ultrasound in pediatric emergency medicine. Curr Opin Pediatr. 2014;26(3):265-271. (Review)
  36. Pershad J, Myers S, Plouman C, et al. Bedside limited echocardiography by the emergency physician is accurate during evaluation of the critically ill patient. Pediatrics. 2004;114(6):e667-e671. (Prospective cohort study; 31 patients)
  37. Spurney CF, Sable CA, Berger JT, et al. Use of a hand-carried ultrasound device by critical care physicians for the diagnosis of pericardial effusions, decreased cardiac function, and left ventricular enlargement in pediatric patients. J Am Soc Echocardiogr. 2005;18(4):313-319. (Prospective cohort study; 23 patients)
  38. Longjohn M, Wan J, Joshi V, et al. Point-of-care echocardiography by pediatric emergency physicians. Pediatr Emerg Care. 2011;27(8):693-696. (Prospective observational study; 70 patients)
  39. Gaspar HA, Morhy SS, Lianza AC, et al. Focused cardiac ultrasound: a training course for pediatric intensivists and emergency physicians. BMC Med Educ. 2014;14:25. (Prospective cohort study; 384 patients)
  40. Lai WW, Geva T, Shirali GS, et al. Guidelines and standards for performance of a pediatric echocardiogram: a report from the Task Force of the Pediatric Council of the American Society of Echocardiography. J Am Soc Echocardiogr. 2006;19(12):1413-1430. (Guidelines)
  41. Rozycki GS, Ballard RB, Feliciano DV, et al. Surgeon-performed ultrasound for the assessment of truncal injuries: lessons learned from 1540 patients. Ann Surg. 1998;228(4):557- 567. (Prospective cohort study; 1540 patients)
  42. Rozycki GS, Feliciano DV, Ochsner MG, et al. The role of ultrasound in patients with possible penetrating cardiac wounds: a prospective multicenter study. J Trauma. 1999;46(4):543-551. (Prospective cohort study; 225 patients)
  43. Jones AE, Tayal VS, Kline JA. Focused training of emergency medicine residents in goal-directed echocardiography: a prospective study. Acad Emerg Med. 2003;10(10):1054-1058. (Prospective observational educational study; 21 participants)
  44. Mayron R, Gaudio FE, Plummer D, et al. Echocardiography performed by emergency physicians: impact on diagnosis and therapy. Ann Emerg Med. 1988;17(2):150-154. (Case series; 156 patients)
  45. Mandavia DP, Hoffner RJ, Mahaney K, et al. Bedside echocardiography by emergency physicians. Ann Emerg Med. 2001;38(4):377-382. (Prospective study; 103 patients)
  46. Frederiksen CA, Juhl-Olsen P, Andersen NH, et al. Assessment of cardiac pathology by point-of-care ultrasonography performed by a novice examiner is comparable to the gold standard. Scand J Trauma Resusc Emerg Med. 2013;21:87. (Prospective cohort study; 102 patients)
  47. Alexander JH, Peterson ED, Chen AY, et al. Feasibility of point-of-care echocardiography by internal medicine house staff. Am Heart J. 2004;147(3):476-481. (Prospective educational study)
  48. Bustam A, Noor Azhar M, Singh Veriah R, et al. Performance of emergency physicians in point-of-care echocardiography following limited training. Emerg Med J. 2014;31(5):369-373. (Prospective cohort study; 100 patients)
  49. Nagdev A, Stone MB. Point-of-care ultrasound evaluation of pericardial effusions: does this patient have cardiac tamponade? Resuscitation. 2011;82(6):671-673. (Review)
  50. Fernandes CJ Jr, Akamine N, Knobel E. Myocardial depression in sepsis. Shock. 2008;30 Suppl 1:14-17. (Review)
  51. Ranjit S, Kissoon N. Bedside echocardiography is useful in assessing children with fluid and inotrope resistant septic shock. Indian J Crit Care Med. 2013;17(4):224-230. (Case series; 22 patients)
  52. Gudmundsson P, Rydberg E, Winter R, et al. Visually estimated left ventricular ejection fraction by echocardiography is closely correlated with formal quantitative methods. Int J Cardiol. 2005;101(2):209-212. (Prospective cohort study; 89 patients)
  53. Randazzo MR, Snoey ER, Levitt MA, et al. Accuracy of emergency physician assessment of left ventricular ejection fraction and central venous pressure using echocardiography. Acad Emerg Med. 2003;10(9):973-977. (Cross-sectional observational study; 94 patients)
  54. Moore CL, Rose GA, Tayal VS, et al. Determination of left ventricular function by emergency physician echocardiography of hypotensive patients. Acad Emerg Med. 2002;9(3):186- 193. (Prospective observational study; 51 adult patients)
  55. Blyth L, Atkinson P, Gadd K, et al. Bedside focused echocardiography as predictor of survival in cardiac arrest patients: a systematic review. Acad Emerg Med. 2012;19(10):1119-1126. (Meta-analysis; 12 studies)
  56. Doniger SJ. Bedside emergency cardiac ultrasound in children. J Emerg Trauma Shock. 2010;3(3):282-291. (Review)
  57. Scaife ER, Rollins MD, Barnhart DC, et al. The role of focused abdominal sonography for trauma (FAST) in pediatric trauma evaluation. J Pediatr Surg. 2013;48(6):1377-1383. (Prospective cohort study; 88 patients)
  58. Schonfeld D, Lee LK. Blunt abdominal trauma in children. Curr Opin Pediatr. 2012;24(3):314-318. (Review)
  59. Sola JE, Cheung MC, Yang R, et al. Pediatric FAST and elevated liver transaminases: an effective screening tool in blunt abdominal trauma. J Surg Res. 2009;157(1):103-107. (Retrospective chart review; 3171 patients)
  60. van Schuppen J, Olthof DC, Wilde JC, et al. Diagnostic accuracy of a step-up imaging strategy in pediatric patients with blunt abdominal trauma. Eur J Radiol. 2014;83(1):206-211. (Prospective cohort study; 122 patients)
  61. * Menaker J, Blumberg S, Wisner DH, et al. 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. J Trauma Acute Care Surg. 2014;77(3):427-432. (Secondary analysis of prospective cohort study; 889 patients)
  62. Pinto F, Valentino M, Romanini L, et al. The role of CEUS in the assessment of haemodynamically stable patients with blunt abdominal trauma. Radiol Med. 2015;120(1):3-11. (Review)
  63. Valentino M, Serra C, Zironi G, et al. Blunt abdominal trauma: emergency contrast-enhanced sonography for detection of solid organ injuries. AJR Am J Roentgenol. 2006;186(5):1361- 1367. (Prospective study; 32 patients)
  64. Valentino M, Serra C, Pavlica P, et al. Blunt abdominal trauma: diagnostic performance of contrast-enhanced US in children--initial experience. Radiology. 2008;246(3):903-909. (Prospective study; 27 patients)
  65. Miele V, Buffa V, Stasolla A, et al. Contrast enhanced ultra-sound with second generation contrast agent in traumatic liver lesions. Radiol Med. 2004;108(1-2):82-91. (Prospective study; 203 patients)
  66. Kirkpatrick AW, Sirois M, Laupland KB, et al. Hand-held thoracic sonography for detecting post-traumatic pneumothoraces: the extended focused assessment with sonography for trauma (EFAST). J Trauma. 2004;57(2):288-295. (Prospective cohort study; 225 patients)
  67. Matsushima K, Frankel HL. Beyond focused assessment with sonography for trauma: ultrasound creep in the trauma resuscitation area and beyond. Curr Opin Crit Care. 2011;17(6):606-612. (Review)
  68. 68. Turner JP, Dankoff J. Thoracic ultrasound. Emerg Med Clin North Am. 2012;30(2):451-473. (Review)
  69. * Ding W, Shen Y, Yang J, et al. Diagnosis of pneumothorax by radiography and ultrasonography: a meta-analysis. Chest. 2011;140(4):859-866. (Meta-analysis)
  70.  Ku BS, Fields JM, Carr B, et al. Clinician-performed beside ultrasound for the diagnosis of traumatic pneumothorax. West J Emerg Med. 2013;14(2):103-108. (Prospective cohort study; 549 patients)
  71. Ianniello S, Di Giacomo V, Sessa B, et al. First-line sonographic diagnosis of pneumothorax in major trauma: accuracy of e-FAST and comparison with multidetector computed tomography. Radiol Med. 2014;119(9):674-680. (Case series; 368 patients)
  72. Ma OJ, Mateer JR. Trauma ultrasound examination versus chest radiography in the detection of hemothorax. Ann Emerg Med. 1997;29(3):312-315. (Secondary analysis of prospective cohort study; 240 patients)
  73. Sisley AC, Rozycki GS, Ballard RB, et al. Rapid detection of traumatic effusion using surgeon-performed ultrasonography. J Trauma. 1998;44(2):291-296. (Prospective cohort study; 360 patients)
  74. Brooks A, Davies B, Smethhurst M, et al. Emergency ultrasound in the acute assessment of haemothorax. Emerg Med J. 2004;21(1):44-46. (Prospective cohort study; 54 patients)
  75. Abboud PA, Kendall J. Emergency department ultrasound for hemothorax after blunt traumatic injury. J Emerg Med. 2003;25(2):181-184. (Prospective cohort study; 142 patients)
  76. Quayle KS, Jaffe DM, Kuppermann N, et al. Diagnostic testing for acute head injury in children: when are head computed tomography and skull radiographs indicated? Pediatrics. 1997;99(5):E11. (Prospective cohort study; 322 patients)
  77. Dunning J, Batchelor J, Stratford-Smith P, et al. A meta-analysis of variables that predict significant intracranial injury in minor head trauma. Arch Dis Child. 2004;89(7):653-659. (Meta-analysis; 16 studies)
  78. Hofman PA, Nelemans P, Kemerink GJ, et al. Value of radiological diagnosis of skull fracture in the management of mild head injury: meta-analysis. J Neurol Neurosurg Psychiatry. 2000;68(4):416-422. (Meta-analysis; 20 studies)
  79. Rabiner JE, Friedman LM, Khine H, et al. Accuracy of point-of-care ultrasound for diagnosis of skull fractures in children. Pediatrics. 2013;131(6):e1757-e1764. (Prospective cohort study; 69 patients)
  80. * Weinberg ER, Tunik MG, Tsung JW. Accuracy of clinician-performed point-of-care ultrasound for the diagnosis of fractures in children and young adults. Injury. 2010;41(8):862- 868. (Prospective cohort study; 212 patients)
  81. Riera A, Chen L. Ultrasound evaluation of skull frac-tures in children: a feasibility study. Pediatr Emerg Care. 2012;28(5):420-425. (Prospective cohort study; 46 patients)
  82. Parri N, Crosby BJ, Glass C, et al. Ability of emergency ultrasonography to detect pediatric skull fractures: a prospective, observational study. J Emerg Med. 2013;44(1):135-141. (Prospective cohort study; 58 patients)
  83. Easter JS, Bakes K, Dhaliwal J, et al. Comparison of PECARN, CATCH, and CHALICE rules for children with minor head injury: a prospective cohort study. Ann Emerg Med. 2014;64(2):145-152. (Prospective cohort study; 1009 patients)
  84. Lichtenstein DA, Meziere GA. Relevance of lung ultrasound in the diagnosis of acute respiratory failure: the BLUE protocol. Chest. 2008;134(1):117-125. (Prospective cohort study; 260 patients)
  85. Lichtenstein DA. Ultrasound examination of the lungs in the intensive care unit. Pediatr Crit Care Med. 2009;10(6):693-698. (Review)
  86. Lichtenstein DA, Mauriat P. Lung ultrasound in the critically ill neonate. Curr Pediatr Rev. 2012;8(3):217-223. (Review)
  87. Chavez MA, Shams N, Ellington LE, et al. Lung ultrasound for the diagnosis of pneumonia in adults: a systematic review and meta-analysis. Respir Res. 2014;15:50. (Meta-analysis; 10 studies, 1172 adult patients)
  88. Copetti R, Cattarossi L. Ultrasound diagnosis of pneumonia in children. Radiol Med. 2008;113(2):190-198. (Prospective cohort study; 79 patients)
  89. Parlamento S, Copetti R, Di Bartolomeo S. Evaluation of lung ultrasound for the diagnosis of pneumonia in the ED. Am J Emerg Med. 2009;27(4):379-384. (Prospective cohort study; 49 patients)
  90. Caiulo VA, Gargani L, Caiulo S, et al. Lung ultrasound characteristics of community-acquired pneumonia in hospitalized children. Pediatr Pulmonol. 2013;48(3):280-287. (Prospective cohort study; 102 patients)
  91. * Shah VP, Tunik MG, Tsung JW. Prospective evaluation of point-of-care ultrasonography for the diagnosis of pneumonia in children and young adults. JAMA Pediatr. 2013;167(2):119-125. (Prospective cohort study; 200 patients)
  92. Esposito S, Papa SS, Borzani I, et al. Performance of lung ultrasonography in children with community-acquired pneumonia. Ital J Pediatr. 2014;40:37. (Prospective cohort study; 103 patients)
  93. Reali F, Sferrazza Papa GF, Carlucci P, et al. Can lung ultrasound replace chest radiography for the diagnosis of pneu-monia in hospitalized children? Respiration. 2014;88(2):112- 115. (Prospective cohort study; 107 patients)
  94. Volpicelli G, Elbarbary M, Blaivas M, et al. International evidence-based recommendations for point-of-care lung ultrasound. Intensive Care Med. 2012;38(4):577-591. (Literature review and expert concensus recommendations)
  95. Nagdev AD, Merchant RC, Tirado-Gonzalez A, et al. Emergency department bedside ultrasonographic measurement of the caval index for noninvasive determination of low central venous pressure. Ann Emerg Med. 2010;55(3):290-295. (Prospective cohort study; 73 patients)
  96. Ferrada P, Anand RJ, Whelan J, et al. Qualitative assessment of the inferior vena cava: useful tool for the evaluation of fluid status in critically ill patients. Am Surg. 2012;78(4):468- 470. (Prospective cohort study; 108 patients)
  97. Feissel M, Michard F, Faller JP, et al. The respiratory variation in inferior vena cava diameter as a guide to fluid therapy. Intensive Care Med. 2004;30(9):1834-1837. (Prospective cohort study; 39 patients)
  98. Lyon M, Blaivas M, Brannam L. Sonographic measurement of the inferior vena cava as a marker of blood loss. Am J Emerg Med. 2005;23(1):45-50. (Prospective cohort study; 31 patients)
  99. Dipti A, Soucy Z, Surana A, et al. Role of inferior vena cava diameter in assessment of volume status: a meta-analysis. Am J Emerg Med. 2012;30(8):1414-1419. (Meta-analysis; 5 studies)
  100. Krause I, Birk E, Davidovits M, et al. Inferior vena cava diameter: a useful method for estimation of fluid status in children on haemodialysis. Nephrol Dial Transplant. 2001;16(6):1203-1206. (Prospective cohort study; 15 patients)
  101. Chen L, Kim Y, Santucci KA. Use of ultrasound measurement of the inferior vena cava diameter as an objective tool in the assessment of children with clinical dehydration. Acad Emerg Med. 2007;14(10):841-845. (Prospective cohort study; 36 patients)
  102. Levine AC, Shah SP, Umulisa I, et al. Ultrasound assessment of severe dehydration in children with diarrhea and vomiting. Acad Emerg Med. 2010;17(10):1035-1041. (Prospective cohort study; 71 patients)
  103. Kathuria N, Ng L, Saul T, et al. The baseline diameter of the inferior vena cava measured by sonography increases with age in normovolemic children. J Ultrasound Med. 2015;34(6):1091-1096. (Prospective observational study; 63 children)
  104. Ng L, Khine H, Taragin BH, et al. Does bedside sonographic measurement of the inferior vena cava diameter correlate with central venous pressure in the assessment of intravascular volume in children? Pediatr Emerg Care. 2013;29(3):337- 341. (Prospective cohort study; 51 patients)
  105. Smith MP, Katz DS, Lalani T, et al. ACR appropriateness criteria® right lower quadrant pain-suspected appendicitis. Ultrasound Q. 2014;31(2):85-91. (Guidelines)
  106. Howell JM, Eddy OL, Lukens TW, et al. Clinical policy: critical issues in the evaluation and management of emergency department patients with suspected appendicitis. Ann Emerg Med. 2010;55(1):71-116. (Guidelines)
  107. Doria AS, Moineddin R, Kellenberger CJ, et al. US or CT for diagnosis of appendicitis in children and adults? A meta-analysis. Radiology. 2006;241(1):83-94. (Meta-analysis; 26 studies)
  108. Krishnamoorthi R, Ramarajan N, Wang NE, et al. Effectiveness of a staged US and CT protocol for the diagnosis of pediatric appendicitis: reducing radiation exposure in the age of ALARA. Radiology. 2011;259(1):231-239. (Retrospective chart review; 1228 patients)
  109. Saucier A, Huang EY, Emeremni CA, et al. Prospective evaluation of a clinical pathway for suspected appendicitis. Pediatrics. 2014;133(1):e88-e95. (Prospective cohort study; 196 patients)
  110. Kaiser S, Frenckner B, Jorulf HK. Suspected appendicitis in children: US and CT--a prospective randomized study. Radiology. 2002;223(3):633-638. (Prospective randomized study; 600 patients)
  111. Srinivasan A, Servaes S, Pena A, et al. Utility of CT after sonography for suspected appendicitis in children: integration of a clinical scoring system with a staged imaging protocol. Emerg Radiol. 2014. (Retrospective chart review; 211 patients)
  112. Ross MJ, Liu H, Netherton SJ, et al. Outcomes of children with suspected appendicitis and incompletely visualized appendix on ultrasound. Acad Emerg Med. 2014;21(5):538-542. (Retrospective chart review; 968 patients)
  113. Ramarajan N, Krishnamoorthi R, Gharahbaghian L, et al. Clinical correlation needed: what do emergency physicians do after an equivocal ultrasound for pediatric acute appendicitis? J Clin Ultrasound. 2014;42(7):385-394. (Retrospective chart review; 620 patients)
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  115. Elikashvili I, Tay ET, Tsung JW. The effect of point-of-care ultrasonography on emergency department length of stay and computed tomography utilization in children with suspected appendicitis. Acad Emerg Med. 2014;21(2):163-170. (Prospective cohort study; 150 patients)
  116. Hryhorczuk AL, Strouse PJ. Validation of US as a first-line diagnostic test for assessment of pediatric ileocolic intussusception. Pediatr Radiol. 2009;39(10):1075-1079. (Retrospective chart review; 812 patients)
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  118. Verschelden P, Filiatrault D, Garel L, et al. Intussusception in children: reliability of US in diagnosis--a prospective study. Radiology. 1992;184(3):741-744. (Prospective cohort study; 83 patients)
  119. * Justice FA, de Campo M, Liem NT, et al. Accuracy of ultrasonography for the diagnosis of intussusception in infants in Vietnam. Pediatr Radiol. 2007;37(2):195-199. (Prospective cohort study; 640 patients)
  120. Bhisitkul DM, Listernick R, Shkolnik A, et al. Clinical application of ultrasonography in the diagnosis of intussusception. J Pediatr. 1992;121(2):182-186. (Prospective cohort study; 65 patients)
  121. Kim JH. US features of transient small bowel intussusception in pediatric patients. Korean J Radiol. 2004;5(3):178-184. (Retrospective review; 34 patients)
  122. Ramsey KW, Halm BM. Diagnosis of intussusception using bedside ultrasound by a pediatric resident in the emergency department. Hawaii J Med Public Health. 2014;73(2):58-60. (Case report)
  123. Kairam N, Kaiafis C, Shih R. Diagnosis of pediatric intussusception by an emergency physician-performed bedside ultrasound: a case report. Pediatr Emerg Care. 2009;25(3):177- 180. (Case report)
  124. Riera A, Hsiao AL, Langhan ML, et al. Diagnosis of intussusception by physician novice sonographers in the emergency department. Ann Emerg Med. 2012;60(3):264-268. (Prospective cohort study; 82 patients)
  125. del-Pozo G, Albillos JC, Tejedor D, et al. Intussusception in children: current concepts in diagnosis and enema reduction. Radiographics. 1999;19(2):299-319. (Review)
  126. Hernanz-Schulman M. Infantile hypertrophic pyloric stenosis. Radiology. 2003;227(2):319-331. (Review)
  127. Teele RL, Smith EH. Ultrasound in the diagnosis of idiopathic hypertrophic pyloric stenosis. N Engl J Med. 1977;296(20):1149-1150. (Case series; 5 patients)
  128. Sivitz AB, Tejani C, Cohen SG. Evaluation of hypertrophic pyloric stenosis by pediatric emergency physician sonography. Acad Emerg Med. 2013;20(7):646-651. (Prospective cohort study; 67 patients)
  129. Bailey PV, Connors RH, Tracy TF Jr, et al. Changing spectrum of cholelithiasis and cholecystitis in infants and children. Am J Surg. 1989;158(6):585-588. (Retrospective chart review; 47 patients)
  130. American College of Emergency Physicians. Emergency ultrasound guidelines. Ann Emerg Med. 2009;53(4):550-570. (Guidelines)
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Publication Information

Joshua Guttman, MD, FRCPC; Bret P. Nelson, MD, RDMS, FACEP;

Publication Date

January 2, 2016

CME Expiration Date

February 1, 2019

Get Permission

CME Information

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