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Published on: April 7, 2023
Point-of-care ultrasound for hip effusion in children: A systematic review and meta-analysis
Cynthia A Gravel1, Jeffrey T Neal1, Joshua Dodderer1
1Division of Emergency Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, United States of America.
Insights
Point-of-care ultrasound (POCUS) is a valuable tool for diagnosing pediatric hip effusion, showing high accuracy in emergency settings. This method aids in evaluating children with hip pain, limp, and inability to bear weight.
Area of Science:
- Pediatric Emergency Medicine
- Diagnostic Imaging
- Musculoskeletal Ultrasound
Background:
- Children presenting with hip pain, limp, or inability to bear weight pose diagnostic challenges.
- Sonography is an effective initial imaging method for detecting hip effusions.
- Point-of-care ultrasound (POCUS) is increasingly recognized for bedside accuracy in pediatric hip assessment.
Purpose of the Study:
- To systematically review and meta-analyze the diagnostic accuracy of POCUS for pediatric hip effusion.
- To evaluate POCUS as a first-line diagnostic tool in emergency and acute care settings.
Main Methods:
- A systematic search of multiple databases (MEDLINE, Embase, Web of Science, CINAHL, Cochrane Central) was conducted.
- Studies assessing POCUS diagnostic accuracy for pediatric hip effusion were included.
- Data extraction and quality assessment (using QUADAS-2) were performed, with meta-analysis using a bivariate mixed effects model.
Main Results:
- Four studies involving 526 hips met the inclusion criteria.
- POCUS demonstrated a pooled sensitivity of 88% (95% CI, 82%-92%) and specificity of 97% (95% CI, 93%-99%).
- Positive likelihood ratio was 35 (95% CI, 12.0-100.8) and negative likelihood ratio was 0.13 (95% CI, 0.08-0.19).
Conclusions:
- POCUS exhibits high specificity and moderate sensitivity for diagnosing hip effusion in children.
- POCUS is a valuable first-line diagnostic modality for pediatric hip complaints in acute care settings.
Introduction:
Children with hip pain, limp and inability to bear weight often present a diagnostic clinical challenge. Sonography is an ideal first-line imaging modality to assess for effusion, and recent literature suggests that point-of-care ultrasound (POCUS) performed by emergency providers can be safely and accurately performed at the bedside. This systematic review and meta-analysis aims to summarize the diagnostic accuracy of POCUS for pediatric hip effusion.
Methods:
MEDLINE, Embase, Web of Science, CINAHL, and Cochrane Central databases were searched through July 2025, with no date limits, using pre-defined criteria for articles assessing the diagnostic accuracy of POCUS for pediatric hip effusion. Data were extracted and quality assessment was performed using the QUADAS-2 tool. Test characteristics were pooled using a bivariate mixed effects model for meta-analysis.
Results:
Four studies, with a total of 526 hips scanned, met our inclusion criteria. The reference standard for all included studies was radiology-performed ultrasonography. POCUS demonstrated a pooled sensitivity of 88% (95% CI, 82%-92%), specificity of 97% (95% CI, 93%-99%), positive likelihood ratio of 35 (95% CI, 12.0-100.8), and negative likelihood ratio of 0.13 (0.08-0.19).
Conclusions:
POCUS has high specificity and moderate sensitivity for hip effusion in children and is a valuable first-line diagnostic tool for evaluating children with hip pain, limp and inability to bear weight in emergency and acute care settings.
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