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

Patricia Vega-Fernandez; Ysabella Esteban; Edward Oberle; Jean-Philippe Proulx-Gauthier; Matthew Clark; Susan Shenoi; Akaluck Thatayatikom; Heather Benham; Emily J Brunner; Leandra Woolnough; Michael Henrickson; Laura R Pratt; Deirdre De Ranieri; Sarah Hoffmann; Ginger Janow; Hulya Bukulmez; Mekibib Altaye; Amy Cassedy; Tracy V Ting; Johannes Roth; CARRA JIA Ultrasound Workgroup

doi:10.3899/jrheum.220382

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

J Rheumatol. 2023 Feb;50(2):236-239. doi: 10.3899/jrheum.220382. Epub 2022 Oct 1.

Authors

Patricia Vega-Fernandez¹, Ysabella Esteban², Edward Oberle³, Jean-Philippe Proulx-Gauthier⁴, Matthew Clark⁵, Susan Shenoi⁶, Akaluck Thatayatikom⁷, Heather Benham⁸, Emily J Brunner⁹, Leandra Woolnough¹⁰, Michael Henrickson², Laura R Pratt¹¹, Deirdre De Ranieri¹², Sarah Hoffmann¹³, Ginger Janow¹⁴, Hulya Bukulmez¹⁵, Mekibib Altaye¹⁶, Amy Cassedy¹⁶, Tracy V Ting², Johannes Roth; CARRA JIA Ultrasound Workgroup

Affiliations

¹ P. 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.
² P. 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.
³ E. Oberle, MD, Nationwide Children's Hospital, Columbus, Ohio, USA.
⁴ J.P. Proulx-Gauthier, MD, FRCPC, Department of Pediatrics, CHU de Québec-Université Laval, Quebec City, Quebec, Canada.
⁵ M. Clark, MD, Department of Pediatrics, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
⁶ S. Shenoi, MBBS, MS, Seattle Children's Hospital and Research Center University of Washington, Seattle, Washington, USA.
⁷ A. Thatayatikom, MD, AdventHealth for Children, Orlando, Florida, USA.
⁸ H. Benham, DNP, APRN, Scottish Rite for Children Dallas, Dallas, Texas, USA.
⁹ E.J. Brunner, DO, Geisinger Medical Center, Danville, Pennsylvania, USA.
¹⁰ L. Woolnough, MD, MSCS, Department of Pediatrics, UFHealth, Gainesville, Florida, USA.
¹¹ L.R. Pratt, MD, University of Nebraska Medical Center, Omaha, Nebraska, USA.
¹² D. De Ranieri, MD, Department of Pediatrics, Northwestern Feinberg School of Medicine, Division of Rheumatology, Ann and Robert H. Lurie Children's Hospital, Chicago, Illinois, USA.
¹³ S. Hoffmann, MD, Children's Hospital of Richmond, Virginia, USA.
¹⁴ G. Janow, MD, MPH, Joseph M. Sanzari Children's Hospital, Hackensack, New Jersey, USA.
¹⁵ H. Bukulmez, MD, Department of Pediatrics, Division of Pediatric Rheumatology, Metro Health Medical System, Case Western Reserve University, Cleveland, Ohio, USA.
¹⁶ M. Altaye, PhD, A. Cassedy, PhD, Department of Pediatrics, University of Cincinnati, Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA.

Abstract

Objective: Musculoskeletal ultrasound (MSUS) is increasingly being used in the evaluation of pediatric musculoskeletal diseases. In order to provide objective assessments of arthritis, reliable MSUS scoring systems are needed. Recently, joint-specific scoring systems for arthritis of the pediatric elbow, wrist, and finger joints were proposed by the Childhood Arthritis and Rheumatology Research Alliance (CARRA) MSUS workgroup. This study aimed to assess the reliability of these scoring systems when used by sonographers with different levels of expertise.

Methods: Members of the CARRA MSUS workgroup attended training sessions for scoring the elbow, wrist, and finger. Subsequently, scoring exercises of B mode and power Doppler (PD) mode still images for each joint were performed. Interreader reliability was determined using 2-way single-score intraclass correlation coefficients (ICCs) for synovitis and Cohen [Formula: see text] for tenosynovitis.

Results: Seventeen pediatric rheumatologists with different levels of MSUS expertise (1-15 yrs) completed a 2-hour training session and calibration exercise for each joint. Excellent reliability (ICC > 0.75) was found after the first scoring exercise for all the finger and elbow views evaluated on B mode and PD mode, and for all of the wrist views on B mode. After a second training session and a scoring exercise, the wrist PD mode views reached excellent reliability as well.

Conclusion: The preliminary CARRA MSUS scoring systems for assessing arthritis of the pediatric elbow, wrist, and finger joints demonstrate excellent reliability among pediatric MSUS sonographers with different levels of expertise. With further validation, this reliable joint-specific scoring system could serve as a clinical tool and scientific outcome measure.

Keywords: diagnostic imaging; juvenile idiopathic arthritis; ultrasonography.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Arthritis, Juvenile*
Child
Elbow
Finger Joint
Humans
Joints / diagnostic imaging
Reproducibility of Results
Ultrasonography / methods
Wrist*

Abstract

Publication types

MeSH terms

Grants and funding