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Feasibility of Implementation of Point-of-Care Musculoskeletal Ultrasound in Joint Status Assessment in Children with Hemophilia

O. Khan1, L. Malec2, A. Rafique3, A. Wood3, M. Brakefield1, S. Akins4, T. Kaltenmark4, N. Bakeer4

1University of Oklahoma Center for Bleeding and Clotting Disorders, Oklahoma City, United States, 2Versiti Blood Center of Wisconsin, Milwaukee, United States, 3Louisiana Center of Bleeding and Clotting Disorders, New Orleans, United States, 4Indiana Hemophilia and Thrombosis Center, Indianapolis, United States

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 November 29, 2023.

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