# Ultrasound in addition to clinical assessment of acute musculoskeletal complaints in bleeding disorders: impact on patient management

## TL;DR

Adding ultrasound to clinical exams for acute musculoskeletal issues in people with bleeding disorders changes diagnosis and treatment in over a third of cases.

## Contribution

This study shows ultrasound significantly impacts patient management in bleeding disorders with acute musculoskeletal complaints.

## Key findings

- Ultrasound changed the diagnosis in 36% of 77 episodes.
- Ultrasound altered treatment in 39% of episodes.
- The number needed to scan for impact was 3.

## Abstract

Ultrasound is increasingly used for musculoskeletal assessment in hemophilia care.

To evaluate the impact of point-of-care ultrasound added to clinical assessment for diagnosis and treatment of acute musculoskeletal episodes in a heterogeneous cohort of children and adults with hemophilia and von Willebrand disease (VWD).

This prospective cross-sectional study consecutively included children and adults with hemophilia or VWD who visited the outpatient clinic with acute musculoskeletal complaints between March 2020 and May 2023. For all episodes, initial diagnosis and treatment determined by clinical assessment were recorded on a case report form. Subsequently, a physiotherapist (M.A.T. and J.B.) with knowledge of the clinical diagnosis performed point-of-care ultrasound. After ultrasound, updated diagnosis and treatment were recorded. Diagnosis and treatment before and after ultrasound were compared, and proportions of change with 95% CIs were determined.

We evaluated 77 episodes in 67 patients (median age, 24 years; IQR, 13-42 years). Before ultrasound, 37 joint bleeds, 13 muscle bleeds, and 27 other diagnoses were diagnosed. After ultrasound, 33 joint bleeds, 11 muscle bleeds, and 33 other diagnoses were confirmed. The diagnosis changed in 28 of 77 episodes (36%; 95% CI, 26%-48%). Nine joint bleeds and 2 muscle bleeds were missed by clinical assessment. Ultrasound findings changed treatment strategy in 30 of 77 episodes (39%; 95% CI, 28%-51%).

Ultrasound in addition to clinical assessment of acute musculoskeletal complaints in people with hemophilia and VWD has an impact on diagnosis (36%) and treatment (39%), which supports the use of ultrasound in acute musculoskeletal complaints in hemophilia and VWD.

•Ultrasound may impact management of acute musculoskeletal episodes in bleeding disorders.•Children and adults with musculoskeletal episodes were assessed clinically and with ultrasound.•Ultrasound changed the diagnosis in 36% and treatment in 39% of the 77 musculoskeletal episodes.•The number needed to scan with ultrasound to achieve diagnostic/therapeutic impact was 3.

Ultrasound may impact management of acute musculoskeletal episodes in bleeding disorders.

Children and adults with musculoskeletal episodes were assessed clinically and with ultrasound.

Ultrasound changed the diagnosis in 36% and treatment in 39% of the 77 musculoskeletal episodes.

The number needed to scan with ultrasound to achieve diagnostic/therapeutic impact was 3.