Submitted by: Eman Tawfik, MD
Edited by: Francisco Gomez, MD and Niranjan Singh, MD
Rardin BP, Verenes MP, Cartwright MS. Ultrasound first for pediatric patients in an electrodiagnostic laboratory. J Clin Neurophysiol
The authors investigated the impact of an ultrasound (US)-first approach, adopted in their EMG lab for pediatric patients. They retrospectively identified pediatric patients who were examined via US prior to EDX tests (US-first group) and those undergoing EDX tests initially (control group). 21 pediatric patients were included in the US-first group and 84 age-matched patients were included in the control group. Authors compared the number of nerves stimulated in NCS and the number of muscles sampled in EMG between groups.
The mean number of muscles sampled in EMG and the mean number of total EDX tests (total number of nerves stimulated in NCS and total number of muscles sampled in EMG) were significantly fewer in the US-first group, compared to the control group.
The authors also presented two cases to demonstrate the impact of using a US-first approach.
In the two presented cases, the US impacted the diagnosis, and guided further investigations. The mean number of nerves in the US-first group was 3.76 versus 6.48 in the control group. The mean number of muscles sampled in the US-first group was 1 compared to 2.66 in the control group. US also helped to discover the pathology including lipoma in one case and diagnosis of Charcot-Marie-Tooth disease in other cases.
The article shows how NM US can be used in the EMG lab to decrease the number of EDX tests and spare the child from painful NCS and EMG studies. It also shows how using a US-first approach can guide further investigations.
Despite the findings, potential concerns of addition of another testing modality include time and cost, though time management is justified by a decrease in the number of nerves tested when using a US-first approach.
Though a small retrospective study, this research demonstrated that a US-first approach in pediatric population may have a potential benefit of reducing the number of nerves/muscles assist during EDX testing, but larger studies are needed to further confirm the impression.
Article of similar interest:
Kang PB, McMillan HJ, Kuntz NL, et al. Utility and practice of electrodiagnostic testing in the pediatric population: An AANEM consensus statement. Muscle Nerve
. 2020;61(2):143-155. doi:10.1002/mus.26752