POCUS Assessment of Bladder Fullness for Girls Awaiting Radiology-Performed Transabdominal Pelvic Ultrasound
| Status: | Completed |
|---|---|
| Conditions: | Hospital, Women's Studies, Pain |
| Therapuetic Areas: | Musculoskeletal, Other, Reproductive |
| Healthy: | No |
| Age Range: | 8 - 18 |
| Updated: | 3/21/2019 |
| Start Date: | September 2015 |
| End Date: | November 5, 2016 |
Point-of-Care-Ultrasound Assessment of Bladder Fullness for Girls Awaiting Radiology-Performed Transabdominal Pelvic Ultrasound: A Randomized Controlled Trial
The purpose of this study is to assess the accuracy and utility of point-of-care ultrasound
(POCUS) of the bladder compared to patient's sensation of bladder fullness in predicting the
ability to successfully perform a comprehensive transabdominal pelvic ultrasound in the
pediatric Emergency Department (ED). We hypothesize that POCUS can more accurately and more
quickly determine adequate bladder fullness to successfully perform transabdominal pelvic
ultrasound than patient's perception of bladder fullness.
(POCUS) of the bladder compared to patient's sensation of bladder fullness in predicting the
ability to successfully perform a comprehensive transabdominal pelvic ultrasound in the
pediatric Emergency Department (ED). We hypothesize that POCUS can more accurately and more
quickly determine adequate bladder fullness to successfully perform transabdominal pelvic
ultrasound than patient's perception of bladder fullness.
Ultrasound (US) is the preferred imaging modality in the pediatric ED in the diagnostic
evaluation of girls with suspected pelvic pathology. In the transabdominal approach, urine
acts as a sonographic acoustic window to image the adnexa and uterus, but this requires a
full bladder. Many high acuity pelvic pathologies presenting to the pediatric ED have
significant morbidity and mortality associated with delays in diagnosis. Despite this,
diagnostic pelvic US is often delayed by the need to fill the bladder, awaiting a patient's
report of subjective sensation of bladder fullness. Images of the bladder using POCUS can be
easily obtained at the bedside by emergency physicians, providing a quick assessment of the
size and shape of the bladder that may be a more accurate, objective measure of bladder
fullness. We aim to assess the utility of POCUS of the bladder compared to patient's
sensation of bladder fullness in this clinical scenario.
This is a pragmatic, randomized controlled trial of a convenience sample of girls being
treated in a pediatric ED who present with an indication for transabdominal pelvic US.
Patients will be randomized to two groups:
1. Standard of care group - Patients will be given consecutive IV fluid boluses until
sensation of maximum bladder fullness followed by transabdominal pelvic US performed by
a radiologist or US technician.
2. Experimental group - Patients will be given consecutive IV fluid boluses until a full
bladder is visualized by the ED physician on POCUS followed by transabdominal pelvic US
performed by a radiologist or US technician.
Patients in both groups will be assessed at 30-minute intervals for sensation of bladder
fullness on a 0-4 Likert Scale, total volume of IVF given per kilogram, and POCUS of the
bladder. Overall time between initial ordering of transabdominal pelvic US (Time 0) to the
time the patient went for successful US will be recorded and compared between the two groups.
Success rate of first attempt at transabdominal pelvic US will also be recorded and compared
between the two groups.
evaluation of girls with suspected pelvic pathology. In the transabdominal approach, urine
acts as a sonographic acoustic window to image the adnexa and uterus, but this requires a
full bladder. Many high acuity pelvic pathologies presenting to the pediatric ED have
significant morbidity and mortality associated with delays in diagnosis. Despite this,
diagnostic pelvic US is often delayed by the need to fill the bladder, awaiting a patient's
report of subjective sensation of bladder fullness. Images of the bladder using POCUS can be
easily obtained at the bedside by emergency physicians, providing a quick assessment of the
size and shape of the bladder that may be a more accurate, objective measure of bladder
fullness. We aim to assess the utility of POCUS of the bladder compared to patient's
sensation of bladder fullness in this clinical scenario.
This is a pragmatic, randomized controlled trial of a convenience sample of girls being
treated in a pediatric ED who present with an indication for transabdominal pelvic US.
Patients will be randomized to two groups:
1. Standard of care group - Patients will be given consecutive IV fluid boluses until
sensation of maximum bladder fullness followed by transabdominal pelvic US performed by
a radiologist or US technician.
2. Experimental group - Patients will be given consecutive IV fluid boluses until a full
bladder is visualized by the ED physician on POCUS followed by transabdominal pelvic US
performed by a radiologist or US technician.
Patients in both groups will be assessed at 30-minute intervals for sensation of bladder
fullness on a 0-4 Likert Scale, total volume of IVF given per kilogram, and POCUS of the
bladder. Overall time between initial ordering of transabdominal pelvic US (Time 0) to the
time the patient went for successful US will be recorded and compared between the two groups.
Success rate of first attempt at transabdominal pelvic US will also be recorded and compared
between the two groups.
Inclusion Criteria:
- Girls age 8-18 presenting to the pediatric Emergency Department who need
transabdominal pelvic ultrasound as determined by their treating providers
Exclusion Criteria:
- History of genitourinary or pelvic anomalies (e.g. neurogenic bladder, urogenital
malformation, ambiguous genitalia, Turner Syndrome, ureterocele, bladder diverticulum,
imperforate hymen); history of pelvic surgery
- Critically ill patients who are unable to consent
- Sensation of maximal bladder fullness/need to void at time of start of the study
- Nonverbal patients or severe cognitive or language delay
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