title: Bedside Ultrasound to Facilitate Early Diagnosis and Ease of Follow-Up in Neurogenic Heterotopic Ossification: A Pilot Study From the Intensive Care Unit.
abstract: To explore the potential role of ultrasound (US) as a bedside tool in intensive care unit patients with presumed neurogenic heterotopic ossification (NHO).
  
  
  
  Tertiary university teaching hospitals.
  
  
  
  Critical care patients with acquired brain injury.
  
  
  
  A multicenter prospective study of critical care patients with possible NHO.
  
  
  
  Following a screening clinical examination, the major joints were evaluated with US, serum laboratory work, and x-ray.
  
  
  
  A total of 310 patients had decreased range of motion by clinical screen and all received US interrogation. Sonographic signs of NHO were identified in 21 of the 310 patients (6.8%), of which 17/21 (81.0%) showed hyperemia; 9/21 (42.8%) showed the reverse zone phenomenon, and 4/21 patients (19.0%) showed the prezone phenomenon. All 21 patients progressed to the zone phenomenon within 15 weeks. Laboratory parameters were not significantly correlated with US (r = 0.11, r = 0.13; P > .05, respectively), whereas x-rays were associated with a mean diagnostic delay of 2 ± 0.5 weeks (P < .05) compared with US. All 21 sonographic NHO patients survived to intensive care unit discharge. Twelve months after admission, 3/21 had died; 6/21 still had abnormalities by x-ray, US, and clinical examination; and 12/21 had resolution by x-ray, US, and clinical examination.
  
  
  
  Our pilot study suggests potential benefits for bedside US in NHO, especially when compared with x-ray or laboratory investigations. These include the possibility of earlier diagnosis, consideration of therapy before ossification, and ease of follow-up. Our study also provides insights into the morphologic, sonographic, radiologic, and clinical course of NHO.
authors.affiliation: Department of Radiology, King's College Hospital, London, United Kingdom (Dr Stefanidis and Messrs Ramnarine, Daneshi, and Sidhu); Department of Critical Care, University of Alberta, Edmonton, Canada (Dr Brindley); Department of Internal Medicine, School of Medicine, University of South Carolina, Columbia (Dr Blaivas); Department of Critical Care, King Saud Medical City, Riyadh, Saudi Arabia (Drs Alharthy and Karakitsos); Department of Critical Care, Keck Medical School, USC, Los Angeles, California (Dr Karakitsos); and Department of Critical Care, General State Hospital of Athens, Greece (Dr Karakitsos).
authors.forename: Konstantinos
authors.initials: K
authors.lastname: Stefanidis
authors.forename: Peter
authors.initials: P
authors.lastname: Brindley
authors.forename: Raymond
authors.initials: R
authors.lastname: Ramnarine
authors.forename: Michael
authors.initials: M
authors.lastname: Blaivas
authors.forename: Mohammad
authors.initials: M
authors.lastname: Daneshi
authors.forename: Paul S
authors.initials: PS
authors.lastname: Sidhu
authors.forename: Abdoulrahman
authors.initials: A
authors.lastname: Alharthy
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Karakitsos
mesh_terms: D000328:Adult; D003422:Critical Care / Q000379:methods; D042241:Early Diagnosis; D005260:Female; D006785:Hospitals, University; D006801:Humans; D007362:Intensive Care Units; D008297:Male; D008875:Middle Aged; D009999:Ossification, Heterotopic / Q000175:diagnosis* / Q000000981:diagnostic imaging*; D010865:Pilot Projects; D000067716:Point-of-Care Testing; D011446:Prospective Studies; D062606:Tertiary Care Centers; D018608:Ultrasonography, Doppler / Q000379:methods*; D055815:Young Adult