Comprehensive and reliable sonographic assessment and scoring system for inflammatory lesions of the paediatric ankle

Author:

Vega-Fernandez Patricia1ORCID,De Ranieri Deirdre2,Oberle Edward3,Clark Matthew4,Bukulmez Hulya5,Lin Clara6,Shenoi Susan7,Thatayatikom Akaluck8,Woolnough Leandra9,Benham Heather10,Brunner Emily11,Henrickson Michael1,Pratt Laura R12,Proulx-Gauthier Jean-Philippe13,Janow Ginger14,Cassedy Amy15,Ting Tracy V1,Roth Johannes16,Roth Johannes,Ting Tracy,Thatayatikom Akaluck,Schutt Christina,Lin Clara,De Ranieri Deirdre,Oberle Edward,Brunner Emily,Janow Ginger,Benham Heather,Bukulmez Hulya,Proulx-Gauthier Jean-Philippe,Woolnough Leandra,Henrickson Michael,Haro Sara,Shenoi Susan,Clark Matthew Thomas,Fernandez Patricia Vega,Ballenger Laura,Esteban Ysabella,

Affiliation:

1. Division of Rheumatology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center , Cincinnati, OH, USA

2. Division of Rheumatology, Department of Pediatrics, Northwestern Feinberg School of Medicine, Ann and Robert H. Lurie Children’s Hospital , Chicago, IL, USA

3. Department of Pediatrics, Nationwide Children’s Hospital , Columbus, OH, USA

4. Department of Pediatrics, Vanderbilt University Medical Center , Nashville, TN, USA

5. Division of Pediatric Rheumatology, Department of Pediatrics, Metro Health Medical System, Case Western Reserve University , Cleveland, OH, USA

6. Department of Pediatrics, Children’s Hospital Colorado , Aurora, CO, USA

7. Seattle Children’s Hospital and Research Center University of Washington , Seattle, WA, USA

8. AdventHealth Medical Group Pediatric Rheumatology and Immunology , Orlando, FL, USA

9. Department of Pediatrics, UFHealth , Gainesville, FL, USA

10. Department of Pediatrics, Scottish Rite for Children , Frisco, TX, USA

11. Department of Pediatrics, Geisinger Medical Center , Danville, PA, USA

12. Department of Pediatrics, University of Nebraska Medical Center , Omaha, NE, USA

13. CHU de Québec-Université Laval , Québec, Canada

14. Joseph M. Sanzari Children’s Hospital , Hackensack, NJ, USA

15. Division of Biostatistics and Epidemiology, Department of Pediatrics, University of Cincinnati, Cincinnati Children’s Hospital Medical Center , Cincinnati, OH, USA

16. Children’s Hospital Eastern Ontario , Ottawa, Canada

Abstract

Abstract Objective The clinical decision-making process in paediatric arthritis lacks an objective, reliable bedside imaging tool. The aim of this study was to develop a US scanning protocol and assess the reliability of B-mode and Doppler scoring systems for inflammatory lesions of the paediatric ankle. Methods As part of the Childhood Arthritis and Rheumatology Research Alliance (CARRA) US group, 19 paediatric rheumatologists through a comprehensive literature review developed a set of standardized views and scoring systems to assess inflammatory lesions of the synovial recesses as well as tendons of the paediatric ankle. Three rounds of scoring of still images were followed by one practical exercise. Agreement among raters was assessed using two-way single score intraclass correlation coefficients (ICC). Results Of the 37 initially identified views to assess the presence of ankle synovitis and tenosynovitis, nine views were chosen for each B-mode and Doppler mode semi-quantitative evaluation. Several scoring exercises and iterative modifications resulted in a final highly reliable scoring system: anterior tibiotalar joint ICC: 0.93 (95% CI 0.92, 0.94), talonavicular joint ICC: 0.86 (95% CI 0.81, 0.90), subtalar joint ICC: 0.91 (95% CI 0.88, 0.93) and tendons ICC: 0.96 (95% CI 0.95, 0.97). Conclusion A comprehensive and reliable paediatric ankle US scanning protocol and scoring system for the assessment of synovitis and tenosynovitis were successfully developed. Further validation of this scoring system may allow its use as an outcome measure for both clinical and research applications.

Funder

National Institutes of Health Clinical and Translational Science Award program

Publisher

Oxford University Press (OUP)

Subject

Pharmacology (medical),Rheumatology

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