Purpose or Case Report: To evaluate the diagnostic accuracy of point-of-care ultrasound (POCUS) in detecting joint changes in children with hemophilic arthropathy when compared to comprehensive US and MRI.
Methods & Materials: Single-center, prospective study examining ankles, knees and elbows (n=39) of boys with inherited bleeding disorders (median age 16 years; range 6-27 years). Same day clinical and imaging joint assessment was performed using the Hemophilia Joint Health Score (HJHS) 2.1, POCUS, comprehensive US and MRI. Two readers reviewed the imaging studies using standardized scoring systems, with discrepancies being adjudicated by a third reader to establish a consensus read. Interreader agreement was assessed with weighted kappa statistics. Diagnostic test performance of POCUS and comprehensive US was benchmarked against MRI findings using sensitivity, specificity, predictive values and accuracy. Spearman correlation was used to correlate clinical and imaging findings.
Results: Moderate interreader agreement was observed for soft-tissue changes (clinical question: “is there a joint bleed?”) using POCUS (k 0.53), which was lower than that of comprehensive US (k 0.73) and of MRI (k 0.78). Interreader agreement for osteochondral lesions (clinical question: “is there arthropathy?”) was poor using POCUS (k 0.09), trailing behind the agreement obtained using comprehensive US (k 0.55) and MRI (k 0.75). POCUS showed reduced accuracy across all joints and joint parameters compared to comprehensive US, particularly for osteochondral changes. A good correlation was noted between total POCUS scores and HJHS (r 0.68, P < .0001), similar to the correlation noted between comprehensive US and HJHS (r 0.66, P < .0001).
Conclusions: POCUS obtained at the patient’s bedside demonstrates lower reliability and accuracy in detecting joint changes in children with hemophilic arthropathy in comparison with comprehensive ultrasound typically obtained in a radiology service.