POCUS Assessment of Bladder Fullness for Girls Awaiting Radiology-Performed Transabdominal Pelvic Ultrasound
Condition: Abdominal Pain; Pelvic Pain
MeSH terms: Pelvic Pain; Abdominal Pain
Study type: Interventional

Summary: 
      The purpose of this study is to assess the accuracy and utility of point-of-care ultrasound
      (POCUS) of the bladder compared to patient's sensation of bladder fullness in predicting the
      ability to successfully perform a comprehensive transabdominal pelvic ultrasound in the
      pediatric Emergency Department (ED). We hypothesize that POCUS can more accurately and more
      quickly determine adequate bladder fullness to successfully perform transabdominal pelvic
      ultrasound than patient's perception of bladder fullness.
    

Detailed description: 
      Ultrasound (US) is the preferred imaging modality in the pediatric ED in the diagnostic
      evaluation of girls with suspected pelvic pathology. In the transabdominal approach, urine
      acts as a sonographic acoustic window to image the adnexa and uterus, but this requires a
      full bladder. Many high acuity pelvic pathologies presenting to the pediatric ED have
      significant morbidity and mortality associated with delays in diagnosis. Despite this,
      diagnostic pelvic US is often delayed by the need to fill the bladder, awaiting a patient's
      report of subjective sensation of bladder fullness. Images of the bladder using POCUS can be
      easily obtained at the bedside by emergency physicians, providing a quick assessment of the
      size and shape of the bladder that may be a more accurate, objective measure of bladder
      fullness. We aim to assess the utility of POCUS of the bladder compared to patient's
      sensation of bladder fullness in this clinical scenario.

      This is a pragmatic, randomized controlled trial of a convenience sample of girls being
      treated in a pediatric ED who present with an indication for transabdominal pelvic US.
      Patients will be randomized to two groups:

        1. Standard of care group - Patients will be given consecutive IV fluid boluses until
           sensation of maximum bladder fullness followed by transabdominal pelvic US performed by
           a radiologist or US technician.

        2. Experimental group - Patients will be given consecutive IV fluid boluses until a full
           bladder is visualized by the ED physician on POCUS followed by transabdominal pelvic US
           performed by a radiologist or US technician.

      Patients in both groups will be assessed at 30-minute intervals for sensation of bladder
      fullness on a 0-4 Likert Scale, total volume of IVF given per kilogram, and POCUS of the
      bladder. Overall time between initial ordering of transabdominal pelvic US (Time 0) to the
      time the patient went for successful US will be recorded and compared between the two groups.
      Success rate of first attempt at transabdominal pelvic US will also be recorded and compared
      between the two groups.
    

Intervention name(s): point-of-care ultrasound
Intervention type(s): Other
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Participant)
Primary purpose: Other