Purpose or Case Report: When evaluating a child with a potential septic hip, prompt diagnosis is important to prevent potential complications such as chondrolysis and avascular necrosis. The diagnosis often requires emergent aspiration of fluid from the hip by a skilled practitioner, traditionally a pediatric radiologist. However, the workforce of pediatric radiologists is dwindling, with retiring physicians being difficult to replace, leading to an overstretched workforce, many of whom may lack interventional skills. Lack of workforce may lead to the restructuring of medical tasks, including hip aspirations. The purpose of this study was to gauge the current participation rate of pediatric radiologists versus other specialties in performing emergency hip aspirations.
Methods & Materials: A brief survey was sent to the Society of Chiefs of Radiology at Children’s Hospitals (SCORCH) to evaluate what subspecialty is currently responsible for performing hip aspirations at the different pediatric centers. The survey was sent via the SCORCH email Listserv. Descriptive statistics and response rate were tabulated.
Results: Of the 98 SCORCH members, 28 completed the survey (response rate: 29%). At 27/28 (96%) institutions, hip aspirations were performed by one subspecialty service. At the remaining hospital (1/28, 4%), hip aspiration cases were split 50%/50% to pediatric radiology during the day and interventional radiology (IR) after hours. Overall, at 18/28 (64%) institutions, hip aspirations were performed by the orthopedics department, at 3.5/28 (13%) by IR, at 2/28 (7%) by emergency physicians, at 2/28 (7%) by the musculoskeletal radiology department, and at 2.5/28 (9%) by pediatric radiologists.
Conclusions: Within the limitations of low survey response rate, orthopedists currently perform a majority of emergent pediatric hip aspirations at major academic pediatric centers. Pediatric radiologists are in the minority of participants. At a time when the pediatric radiology workforce is markedly stretched, and new clinical algorithms must be found to address clinical needs, the performance of hip aspirations appears to have shifted to orthopedic surgeons.