Background/Purpose: Musculoskeletal ultrasound (MSUS) use in the care of pediatric rheumatology patients is increasing. Yet, despite the growing availability of MSUS, it remains unclear how best to utilize ultrasound within a busy pediatric rheumatology clinic – and how its results might affect patient care. A questionnaire was developed to assess the following: reasons for referral, correlation with clinical assessment, changes to management, and the patient/parent experience. The aim of this study is to evaluate physicians’ responses on the utility and impact of MSUS.

Methods: Beginning September 2016, pediatric rheumatology providers from a large tertiary care center with an established MSUS clinic were given a short questionnaire after the completion of a patient MSUS session. The questionnaire included 4 main outcome variables: normal or abnormal MSUS findings, consistency of MSUS results with clinical exam, family’s response to MSUS, and impact on management decisions. Secondary outcomes were: reasons for referral, how MSUS findings correlate to clinical exam (better, worse, or same), aid in family’s understanding of diagnosis, and influence on clinical management – (no change, maximize dose of medication, perform joint injection, or other). Descriptive analysis was performed on collected responses with frequency distribution reported for each variable.

Results: Survey responses were collected on 86 patients. The majority of referrals were placed to evaluate the extent of disease activity. Other reasons included the identification of active joint/tendon(s) for possible joint injection and in instances of discordance between clinical exam and patient symptoms. 80% of the MSUS results were abnormal; and 51% of the time, providers did not anticipate the results. While 51% of MSUS findings were consistent with clinical exam, 41% identified more active joint/tendon(s). 66.3% of the time MSUS result had an impact on management decision. Of the 57 cases where MSUS influenced clinical management: 46% had medications maximized and 44% underwent joint injection. Providers reported that 97% of families found MSUS helpful in general; while 81% found it useful in their understanding of their child’s disease.

Conclusion: MSUS is a valuable tool to complement clinical examination in the care of children with rheumatologic disease. For a majority of referred patients, MSUS helped to assess disease activity and shape clinical management. MSUS can be an important screening tool in identifying worsening, or improving, disease than may be clinically apparent. This ongoing study suggests that there may be a role for MSUS in educating parents/children about their disease. A survey of families is needed to better clarify the impact of MSUS on their understanding of their disease.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/assessing-the-utility-and-impact-of-musculoskeletal-ultrasound-in-a-large-pediatric-rheumatology-clinic/