POCUS-DSA can accurately diagnose transient synovitis in children: JAMA

Haifa, Israel: A combination of point-of-care-ultrasound (POCUS) and decision-support checklist can help in accurate diagnosis of transient synovitis (TS) in children and avoiding unnecessary blood tests, suggests a recent study in JAMA Network Open.

Transient synovitis is inflammation in the hip joint characterized clinically by acute hip pain. Its diagnosis is confirmed by excluding other severe diseases such as osteomyelitis, septic arthritis, and Legg-Calvé-Perthes disease. Ultrasound examination frequently reveals hip effusion.

The POCUS-DSA (decision-support algorithm) includes a set of 5 clinical criteria that must be met, followed by bedside ultrasonography examination of the hip joint

Against the above background Marah Zoabi, Technion-Israel Institute of Technology, Haifa, Israel, and colleagues aimed to evaluate the performance of the POCUS-DSA in the diagnosis of TS among children presenting to the pediatric emergency department (ED).

For this purpose, the researchers looked at data gathered from 1,461 children with nontraumatic hip tenderness between October and November 2020. 

The POCUS algorithm was applied to 621 patients (429 boys, 192 girls) with an average age of 5.5 years. Out of these patients, 539 were correctly diagnosed as having transient synovitis. Meanwhile, 22 patients were correctly diagnosed as not having synovitis, and 54 were misdiagnosed as not having synovitis, but they were correctly diagnosed at follow-up visits.

Six emergency department patients were misdiagnosed as having synovitis, but they were found to have another condition at follow-up visits.

The algorithm showed high sensitivity at 90.9% and high positive predictive value at 98.9%. Specificity, meanwhile, was 78.6% and negative predictive value was 28.9%.

"To our knowledge, this study is the first to suggest a rule-in diagnostic tool for transient synovitis, instead of one of exclusion," Zoabi and colleagues wrote. "The traditional approach advocates the use of laboratory tests to differentiate between transient synovitis and other serious diseases."

The algorithm's positive likelihood ratio of 4.25 suggests it can be helpful in ruling in the diagnosis of transient synovitis, they concluded. 

Reference:

The study titled, "Evaluation of a Point-of-Care Ultrasonography Decision-Support Algorithm for the Diagnosis of Transient Synovitis in the Pediatric Emergency Department," is published in JAMA Network Open.

DOI: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2781930