Abstract Number: PB1074
Meeting: ISTH 2020 Congress
Theme: Hemophilia and Rare Bleeding Disorders » Hemophilia - Clinical
Background: Hemophilic arthropathy results from repeated hemarthrosis in patients with hemophilia. Objective evaluation of joint status using point of care musculoskeletal ultrasound (POC-MSKUS) may provide longitudinal joint assessment and complement acute bleeding episode evaluation. Ultrasound is cost-effective, accessible, non-radiating, and sensitive to soft tissue changes in early arthropathy. Wide-scale implementation of POC-MSKUS in hemophilia treatment centers is hindered by concerns about feasibility of implementation in the comprehensive care model.
Aims: To evaluate the feasibility of implementation of POC-MSKUS in the pediatric comprehensive hemophilia care model.
Methods: Pediatric patients with hemophilia A or B underwent bilateral elbows, knees and ankles POC-MSKUS evaluation by a pediatric hematologist or physical therapist with 1-5 years of scanning experience and prior formal training. Joints were scored using the Hemophilia Early Arthropathy Detection with Ultrasound (HEAD-US) system, and read by a second blinded hematologist or physical therapist. Intraclass Correlation Coefficient (ICC) was used to assess inter-rater reliability of scores. Feasibility was assessed by recruitment rate, proportion of patients completing POC-MSKUS in the allotted time frame, and 5-point Likert scale patient satisfaction survey.
Results: 25 patients underwent POC-MSKUS evaluation, age 4-18 (mean 9.8 years), 84% were severe and 88% on prophylaxis. Recruitment rate was 100%, all 6 joint POC-MSKUS evaluations were completed in under 75 minutes (mean 47, CI 95% 41.5-52.5). Participants reported highly favorable satisfaction scores on a 5-point Likert scale (mean 4.8, CI 95% 4.68-4.92) (Table 1). Preliminary results for inter-rater reliability were fair for knees (ICC 0.39) and excellent for elbows (ICC 0.96), ankles (ICC 0.96), and total joint scores (ICC 0.96) (Table 2).
Conclusions: We demonstrate that POC-MSKUS can be feasibly implemented in the comprehensive hemophilia care model with good inter-rater reliability in ultrasound assessment of hemophilic arthropathy between different providers. Formal training, teamwork and maintenance of competence are key to successful implementation.
| Feasibility Measures | Value |
| Recruitment rate | 25/25 (100%) |
| Patients completed 6 joint evaluation by POC-MSKUS | 25/25 (100%) |
| 6 joint POC-MSKUS evaluation completed in <75 min | 25/25 (100%) |
| Mean time for POC-MSKUS evaluation, (95% CI) | 47 min (41.5, 52.5) |
| Number of trained providers completing each POC-MSKUS evaluation | 2 |
| Average patient satisfaction score (range 1-5), (95% CI) | 4.8 (4.68, 4.92) |
[Measures of feasibility.]
| HEAD-US Score | % Correlation | ICC |
| Elbow (n=50) | 94 % | 0.96 |
| Knee (n=50) | 90 % | 0.39 |
| Ankle (n=50) | 86 % | 0.96 |
| Soft Tissue (n=150) | 95 % | 0.74 |
| Cartilage (n=150) | 94 % | 0.92 |
| Bone (n=150) | 97 % | 0.53 |
| Joint additive score (n=25) | 72 % | 0.96 |
[Inter-rater reliability of HEAD-US scores expressed as percent correlation and Intraclass Correlation Coefficient (ICC).]
To cite this abstract in AMA style:
Khan O, Malec L, Rafique A, Wood A, Brakefield M, Akins S, Kaltenmark T, Bakeer N. Feasibility of Implementation of Point-of-Care Musculoskeletal Ultrasound in Joint Status Assessment in Children with Hemophilia [abstract]. Res Pract Thromb Haemost. 2020; 4 (Suppl 1). https://abstracts.isth.org/abstract/feasibility-of-implementation-of-point-of-care-musculoskeletal-ultrasound-in-joint-status-assessment-in-children-with-hemophilia/. Accessed December 2, 2022.« Back to ISTH 2020 Congress
ISTH Congress Abstracts - https://abstracts.isth.org/abstract/feasibility-of-implementation-of-point-of-care-musculoskeletal-ultrasound-in-joint-status-assessment-in-children-with-hemophilia/