The use of point of care ultrasound in the evaluation of pediatric soft tissue neck masses

• Published in: The American journal of emergency medicine Vol. 37; no. 8; pp. 1466 - 1469
• Main Authors: Levine, Marla C., Arroyo, Alexander, Likourezos, Antonios, Homel, Peter, Dickman, Eitan
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.08.2019; Elsevier Limited
• Subjects: Adolescent; Age; Agreements; Antibiotics; Child; Child, Preschool; Clinical decision making; Computed tomography; Cysts; Decision making; Diagnosis; Emergency management; Emergency medical care; Emergency medical services; Emergency Service, Hospital; Female; Head and Neck Neoplasms - diagnostic imaging; Humans; Infant; Inflammation; Laboratories; Lymphatic system; Male; Neck; Neck - diagnostic imaging; Neck mass; Patients; Pediatric emergency medicine; Pediatrics; Pilot Projects; Point of care ultrasound; Point-of-Care Systems; Prospective Studies; Radiology; Reproducibility of Results; Soft Tissue Neoplasms - diagnostic imaging; Statistical analysis; Tissues; Tomography, X-Ray Computed; Ultrasonic imaging; Ultrasonography; Ultrasound; Neck mass; Pediatric emergency medicine; Pediatrics; Point of care ultrasound
• ISSN: 0735-6757; 1532-8171
• DOI: 10.1016/j.ajem.2018.10.048

Most soft tissue neck masses represent benign inflammatory or infectious processes; however, in some cases the diagnosis is not clear and a broader differential must be considered. The aim of this study was to compare point-of-care ultrasound (POCUS) to radiology department imaging (RDI) in the diagnosis of soft tissue neck masses. This prospective pilot study involved a convenience sample of patients ranging in age from 1 month to 18 years of age presenting to the Pediatric Emergency Department (PED) with a soft tissue neck mass. All children who presented to the PED with soft tissue neck mass at times when an investigator was in the department, and who were candidates for enrollment, underwent a POCUS. The managing pediatric emergency medicine (PEM) provider determined whether RDI was indicated. The results of the POCUS sonologist and radiologist were compared. The kappa statistic was used to analyze agreement with p < 0.05 denoting statistical significance. Twenty-seven patients were enrolled into the study. Twenty-two received radiology ultrasound (RUS), 3 patients received CT, and 2 patients received both RUS and CT. There was agreement between POCUS and RDI diagnoses in 21/27 cases (78%). Accordingly, overall concordance between POCUS and RDI diagnoses was good: the kappa statistic comparing diagnoses obtained by POCUS versus RDI was 0.69 (p < 0.001). This prospective pilot study describes the reliability of POCUS as an imaging modality in the management of patients with undifferentiated soft tissue neck masses. POCUS demonstrated good agreement with RDI as a bedside imaging tool in the evaluation of pediatric soft tissue neck masses.