Reliability of a Novel Pediatric Joint-Specific Scoring System for the Elbow, Wrist and Finger Joints

Patricia Vega-Fernandez¹, Ysabella Esteban², Edward Oberle³, Jean-Philippe Proulx-Gauthier⁴, Matthew Clark⁵, Hulya Bukulmez⁶, Susan Shenoi⁷, Akaluck Thatayatikom⁸, Heather Benham⁹, Emily Brunner¹⁰, Leandra Woolnough⁸, Michael Henrickson¹, Laura Ballenger³, Deidre DeRanieri¹¹, Sarah Hoffmann¹², Ginger Janow¹³, Mekibib Altaye¹⁴, Amy Cassedy², Johannes Roth¹⁵ and Tracy Ting¹, ¹Cincinnati Children's Hospital Medical Center, Cincinnati, OH, ²Cincinnati Children's Hospital and Medical Center, Cincinnati, OH, ³Nationwide Children's Hospital, Columbus, OH, ⁴CHU de Quebec - Universite Laval, Québec City, QC, Canada, ⁵Vanderbilt University Medical Center, Nashville, TN, ⁶MetroHealth Medical Center, Case Western Reserve, Pepper Pike, OH, ⁷Seattle Children's Hospital, Seattle, WA, ⁸University of Florida, Gainesville, FL, ⁹Scottish RIte Hospital, North Richland Hills, TX, ¹⁰Geisinger, Bloomsburg, PA, ¹¹Lurie Children's Hospital, Chicago, IL, ¹²Children's Hospital of Richmond at VCU, Richmond, VA, ¹³Joseph M. Sanzari Children's Hospital at Hackensack Meridian Health, Glen Rock, NJ, ¹⁴Cincinnati Children's Hospital, Cincinnati, OH, ¹⁵University of Ottawa, Ottawa, ON, Canada

Meeting: ACR Convergence 2021

Keywords: Imaging, Pediatric rheumatology, Ultrasound

Session Information

Date: Saturday, November 6, 2021

Session Title: Imaging of Rheumatic Diseases Poster (0149–0182)

Session Type: Poster Session A

Session Time: 8:30AM-10:30AM

Background/Purpose: The clinical decision-making process in pediatric arthritis lacks an objective, reliable bedside imaging tool. Musculoskeletal ultrasound (MSUS) is increasingly being utilized in children. In order to provide objective assessments of arthritis, reliable scoring systems are needed. Recently, a joint-specific scoring system for the assessment of arthritis of the pediatric elbow, wrist and finger joints were proposed[1]. These scoring systems have excellent reliability when used by experienced ultrasonographers ( >7 years of experience). This study aims to assess the reliability of a B-Mode and Power Doppler (PD) scoring system for arthritis in the pediatric elbow, wrist and finger when used by sonographers with different levels of expertise.

Methods: As part of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) MSUS workgroup, a 2-hour training session and calibration exercise for each target joint was completed. Subsequently, B-mode and PD scoring exercises of still-images for each targeted joint were performed. Agreement between raters was determined using two-way single score intra-class correlation coefficients (ICC).

Results: 17 pediatric rheumatologists with different levels of ultrasound expertise (1 – 15 years) completed a 2-hour training session and calibration exercise for each targeted joint. Table 1 shows the inter-rater reliability obtained after the scoring exercise was completed for each joint. In general, there was excellent agreement for all B-mode views of the elbow, wrist, and finger joints. The reliability for PD views was excellent for the elbow and finger but was good for the dorsal ulnar recess and tendon views.

Conclusion: This effort identified the need for further training in PD settings and its scoring system(s). A training exercise and calibration exercise addressing the identified needs is ongoing. A novel BM and PD scoring systems for assessing arthritis of the pediatric elbow, wrist and finger joints were shown to have excellent reliability among pediatric MSUS sonographers with different levels of expertise. This reliable joint-specific scoring system for pediatric arthritis could serve as a clinical tool and outcome measure for scientific purposes with further refinement and validation.

1. Vega-Fernandez P, T.T., Oberle E, Figueroa J, McCracken C, Roth J., Musculoskeletal Ultrasound Study in Childhood Arthritis: A Limited Examination [abstract]. Arthritis Rheumatol, 2020. 72.

Disclosures: P. Vega-Fernandez, None; Y. Esteban, None; E. Oberle, None; J. Proulx-Gauthier, None; M. Clark, None; H. Bukulmez, None; S. Shenoi, Pfizer, 2; A. Thatayatikom, None; H. Benham, None; E. Brunner, None; L. Woolnough, None; M. Henrickson, None; L. Ballenger, None; D. DeRanieri, None; S. Hoffmann, None; G. Janow, None; M. Altaye, None; A. Cassedy, None; J. Roth, None; T. Ting, None.

To cite this abstract in AMA style:

Vega-Fernandez P, Esteban Y, Oberle E, Proulx-Gauthier J, Clark M, Bukulmez H, Shenoi S, Thatayatikom A, Benham H, Brunner E, Woolnough L, Henrickson M, Ballenger L, DeRanieri D, Hoffmann S, Janow G, Altaye M, Cassedy A, Roth J, Ting T. Reliability of a Novel Pediatric Joint-Specific Scoring System for the Elbow, Wrist and Finger Joints [abstract]. Arthritis Rheumatol. 2021; 73 (suppl 9). https://acrabstracts.org/abstract/reliability-of-a-novel-pediatric-joint-specific-scoring-system-for-the-elbow-wrist-and-finger-joints/. Accessed February 3, 2023.

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