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Reliability of the Pediatric Specific Musculoskeletal Ultrasound Scoring Systems for the Elbow, Wrist, and Finger

Patricia Vega-Fernandez1, Ysabella Esteban2, Edward Oberle3

  • 1P. Vega-Fernandez, MD, MSc, Y. Esteban, MD, M. Henrickson, MD, MPH, T.V. Ting, MD, MSc, Department of Pediatrics, University of Cincinnati, Division of Rheumatology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA; patricia.vegafernandez@cchmc.org.

The Journal of Rheumatology
|October 1, 2022
PubMed

Insights

Pediatric musculoskeletal ultrasound (MSUS) scoring systems for elbow, wrist, and finger arthritis show excellent reliability among sonographers with varying expertise. These validated systems can aid in clinical assessment and research for childhood arthritis.

Area of Science:

  • Pediatric Rheumatology
  • Musculoskeletal Imaging
  • Ultrasound Diagnostics

Background:

  • Musculoskeletal ultrasound (MSUS) is vital for evaluating pediatric musculoskeletal conditions.
  • Objective assessment of pediatric arthritis requires reliable MSUS scoring systems.
  • The Childhood Arthritis and Rheumatology Research Alliance (CARRA) developed joint-specific scoring systems for pediatric elbow, wrist, and finger joints.

Purpose of the Study:

  • To evaluate the interreader reliability of newly developed CARRA MSUS scoring systems for pediatric elbow, wrist, and finger joint arthritis.
  • To determine if sonographers with varying levels of expertise can reliably use these scoring systems.

Main Methods:

  • Seventeen pediatric rheumatologists with 1-15 years of MSUS experience underwent training for scoring elbow, wrist, and finger joints.
  • Scoring exercises using B-mode and power Doppler (PD) mode images were conducted.
  • Interreader reliability was assessed using intraclass correlation coefficients (ICCs) for synovitis and Cohen's kappa for tenosynovitis.

Main Results:

  • Excellent reliability (ICC > 0.75) was achieved for finger and elbow joints (B-mode and PD) and wrist joints (B-mode) after the initial training and scoring.
  • Following a second training session and scoring exercise, excellent reliability was also demonstrated for wrist joint PD-mode views.
  • The study involved 17 pediatric rheumatologists with diverse MSUS experience.

Conclusions:

  • The preliminary CARRA MSUS scoring systems for pediatric elbow, wrist, and finger joint arthritis exhibit excellent reliability across sonographers with different expertise levels.
  • These reliable, joint-specific scoring systems have the potential to become valuable clinical tools and scientific outcome measures in pediatric rheumatology.
  • Further validation of these MSUS scoring systems is recommended.
Abstract

Keywords:
diagnostic imagingjuvenile idiopathic arthritisultrasonography

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