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