BULLET: Bladder Ultrasound Limits Length (of Time), Expedites Treatment
Condition: Point-of-Care Bladder Ultrasound; Urethral Catheter
Study type: Interventional

Summary: 
      In this study patients presenting to the pediatric ER with abdominal or pelvic complaints
      will be randomized to urethral bladder catheter or bladder ultrasound to compare time to
      completion of successful pelvic ultrasound, as determined by full visualization of uterus and
      ovaries.
    

Detailed description: 
      In this study, we will enroll female pediatric emergency department (ED) patients presenting
      with a diagnosis of abdominal pain who may have a transabdominal pelvic ultrasound ordered by
      their treating physician (or nurse practitioner). In order to maximize the visualization of
      organs deep within the pelvis such as the ovaries and uterus, the patient's bladder must be
      full. The current practice at our institution, as well as numerous others, is to have a
      bladder catheter placed immediately when a transabdominal pelvic ultrasound is ordered, and
      then to fill the bladder in a retrograde manner in order to provide enhanced visualization of
      the pelvic structures. The process of inserting a bladder catheter into a pediatric patient
      is an invasive procedure which can be traumatic and painful to the patient. Additionally, if
      the patient's bladder is already full, this procedure may be unnecessary.

      In this study, a point-of-care bladder ultrasound will be performed, upon enrollment of a
      patient by a study bedside sonographer (our pediatric emergency department nurse
      practitioners), to assess degree of bladder fullness. This measurement will then be repeated
      serially while the patient is receiving hydration and the ultrasound will be performed when
      the bladder is full. We hypothesize that this work flow will result in an equivalent time to
      transabdominal pelvic ultrasound completion and will reduce the number of potentially
      traumatic and painful, invasive urethral bladder catheterizations.
    

Intervention name(s): Bladder Ultrasound; Standard of Care
Intervention type(s): Device; Other
Intervention description(s): Bladder fullness will be assessed upon enrollment and if not full, the patient will receive hydration, determined by treating physician, and the bladder ultrasound will be repeated every 30 minutes until the patient states that the bladder is "full," or until bladder is deemed full based on a previously validated bladder fullness qualitative scale, at which point patients in this group will proceed to undergo pelvic ultrasound.; Per institution protocol, patients in the standard of care group will have urethral (bladder) catheter placed immediately after the order for pelvic ultrasound and will undergo retrograde bladder filling as determined by the radiologist/ultrasonographer to the point necessary to fully visualize pelvic structures.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Other
Keywords: Ovarian Torsion; Point-of-Care; Pelvic pain; Bedside Ultrasound