Reliability of the Pediatric Specific Musculoskeletal Ultrasound Scoring Systems for the Elbow, Wrist and Finger Joints.
Objective: Musculoskeletal ultrasound (MSUS) is increasingly being utilized 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 aims to assess 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. Inter-reader reliability was determined using two-way single score intra-class correlation coefficients (ICC) for synovitis and Cohen's kappa for tenosynovitis.
Results: Seventeen pediatric rheumatologists with different levels of MSUS expertise (1 - 15 years) 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 of 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.
Conclusions: 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. This reliable joint-specific scoring system could serve as a clinical tool and scientific outcome measure with further validation.