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POCUS for Pyloric Stenosis

January 3, 2022

Written by Justin Moher, SAEM Academy of Emergency Ultrasound

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Point-of-care ultrasound (POCUS) for hypertrophic pyloric stenosis (HPS) is accurate, can be incorporated into a protocol with radiology-performed ultrasound (RADUS) without delaying treatment, and can reduce ED length of stay (LOS).

Why does this matter?
Hypertrophic stenosis is a rare but serious cause of vomiting in young infants and is often difficult to distinguish early from benign causes of vomiting based on clinical history or physical exam alone. Ultrasound, typically performed by radiology, is the diagnostic test of choice when confirming pyloric stenosis. How does POCUS fare?

Palpating pyloric olives is the pits…POCUS them instead!
This single center, retrospective study examined a cohort of infants younger than 90 days who presented to a tertiary care hospital Emergency Department with a complaint of vomiting, a clinical concern for HPS and who had an ultrasound performed. Based on established ED flow, infants presenting during hours with radiology in-house coverage (weekdays, non-holidays, 9a-5p) had RADUS only. Otherwise, a bedside study would be performed by pediatric emergency medicine attendings and fellows with POCUS experience. RADUS would follow if positive on POCUS or if concerning symptoms persisted after negative POCUS. The study found a sensitivity for POCUS of 96.6% and a specificity of 94% in detecting HPS. ED LOS and time to disposition were shorter in the POCUS-performed group. The protocol of POCUS followed by RADUS for positive findings or persistence of symptoms did not delay treatment compared to those who had RADUS alone.

Source
Feasibility of Point-of-Care Ultrasound for Diagnosing Hypertrophic Pyloric Stenosis in the Emergency Department. Pediatr Emerg Care. 2021 Nov 1;37(11):550-554. doi: 10.1097/PEC.0000000000002532.

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