The title tells it all; if you do something yourself, it happens faster. Case closed...
But perhaps there is a little more we can learn from this paper.
These authors from beautiful Charlottesville, Virginia looked retrospectively at 62 patients who got an ultrasound for possible septic arthritis in their ED.
They compared the group that had the ultrasound done by ED doctors (POCUS) vs. those done in radiology. No surprise the POCUS group had the study done faster; about 1 hour vs. 3 hours.
They also looked at time to arthrocentesis which was also faster when performed by the ED doctor; about 3 hours vs. 10 hours.
Of course, this study was only from a single center, it was not randomized, and they had very small numbers. Only 10 arthrocentesis were performed by the ED doctors over 3 years. It can make no genuine claims about safety.
As ED doctors, we are very happy at tapping various joints. I’ve done tons of knees. And some shoulders, elbows, wrists, ankles and toes. But I’ve never aspirated a hip.
For some reason the hip has been taboo. Perhaps it is due to the less common nature and the higher incidence in the pediatric population. It's a deeper joint and more difficult to physically confirm the presence of an effusion. Furthermore, historic blind aspiration techniques were outside our realm.
This is not the first study looking at POCUS to guide hip arthrocentesis in the ED and we are now supported by a growing literature base.
EP’s are clearly owning ultrasound guided needle-based procedures. Perhaps hip arthrocentesis will eventually fall to the responsibility of the Emergency Physician.
Thom C, Ahmed A, Kongkatong M, et al. Point-of-care hip ultrasound leads to expedited results in emergency department patients with suspected septic arthritis. JACEP Open 2020;1:512-20. [link to full text article]
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