Bedside Ultrasound Diagnosis of Nonangulated Distal Forearm Fractures in the Pediatric Emergency Department

Chaar-Alvarez, Frances M; Warkentine, Fred H.; Cross, Keith P.; Herr, S.; Paul, Ronald I.

doi:10.1097/pec.0b013e318235e228

Cited by 77 publications

(72 citation statements)

References 26 publications

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“…All studies reported both the sensitivity and specificity of PoCUS, and LRs were calculated from these values when the authors did not include them in their manuscripts. Twenty-five studies 7,[20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37][38][39][41][42][43][44] were included, ranging from 26 to 653 patients. Collectively, these studies included 2,982 patients and identified 1,200 fractures, with fracture prevalence ranging from 7% to 71% (aggregate prevalence of 40.2%).…”

Section: Study Characteristicsmentioning

confidence: 99%

“…Collectively, these studies included 2,982 patients and identified 1,200 fractures, with fracture prevalence ranging from 7% to 71% (aggregate prevalence of 40.2%). Twelve of the 25 (48%) studies focused on one body area only, either the forearm 7,[20][21][22][23][24][25][26] or the ankle, 27-30 and 13 of 25 (52%) studies recruited exclusively pediatric patients. 7,[20][21][22][23][24][25][26]31,[36][37][38][39] Sensitivity for the detection of LBFs with PoCUS ranged from 64.7% to 100%, with 20 of 25 (80%) studies achieving rates of > 90%.…”

Section: Study Characteristicsmentioning

confidence: 99%

“…7,[20][21][22][23][24][25]39,43,44 Forest plots of the included studies' sensitivity and specificity are shown in Figure 4. The studies' pooled test characteristics were as follows: sensitivity 93.1% (95% CI, 87.2%-96.4%), specificity 92.9% (95% CI, 86.6%-96.4%), LR(+ ) 14.1 (95% CI, 6.71-25), and LR(-) 0.08 (95% CI, 0.04-0.15).…”

Section: Meta-analysis Of Selected Studiesmentioning

confidence: 99%

“…Only 3 of 30 (10%) studies reported on the inter-rater reliability of PoCUS: 78% agreement in one study, and kappa values of 0.57 and 0.92 in two others. 23,40,41 Only one study explicitly reported on a quality assurance process, with one senior sonologist reviewing all enrolled patients' scans. 43 Twenty-nine studies used plain radiographs as the only reference test for LBFs, with one using computed tomography as a secondary confirmatory tool only if necessary.…”

Section: Risk Of Biasmentioning

confidence: 99%

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Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis

Chartier

Bosco

Lapointe‐Shaw

et al. 2016

CJEM

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Objectives: Long bone fractures (LBFs) are among the most frequent traumatic injuries seen in emergency departments. Reduction and immobilization is the most common form of treatment for displaced fractures. Point-of-care ultrasound (PoCUS) is a promising technique for diagnosing LBFs and assessing the success of reduction attempts. This article offers a comprehensive review of the use of PoCUS for the diagnosis and reduction of LBFs. Data source: MEDLINE and EMBASE databases were searched through July 19, 2015. Study selection: We included prospective studies that assessed test characteristics of PoCUS in 1) the diagnosis or 2) the reduction of LBFs. The methodological quality of the included studies was evaluated using the Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2) tool. Data extraction: Thirty studies met inclusion criteria (n = 3,506; overall fracture rate 48.0%). Test characteristics of PoCUS for the diagnosis of LBFs were as follows: sensitivity 64.7%-100%, specificity 79.2%-100%, positive likelihood ratio (LR) 3.11-infinity, and negative LR zero-0.45. Sensitivity and specificity for the adequate reduction of LBFs with PoCUS were 94%-100% and 56%-100%, respectively. PoCUS diagnosis of pediatric forearm fractures in 10 studies showed a pooled sensitivity of 93.1% (95% confidence interval [CI], 87.2%-96.4%) and specificity of 92.9% (95% CI, 86.6%-96.4%), and PoCUS diagnosis of adult ankle fractures in four studies showed a pooled sensitivity of 89.5% (95% CI, 77.0%-95.6%) and specificity of 94.2% (95% CI, 86.1%-97.7%). Conclusion: PoCUS demonstrates good diagnostic accuracy in all LBFs studied, especially in pooled results of diagnosis of pediatric forearm and adult ankle fractures. PoCUS is an appropriate adjunct to plain radiographs for LBFs. RÉSUMÉObjectifs: Les fractures des os longs (FOL) figurent parmi les blessures traumatiques les plus fréquentes au service des urgences, et les traitements les plus courants des fractures avec déplacement consistent en la réduction et l'immobilisation du membre touché. L'échographie au point de service (EPS) est une technique prometteuse dans le diagnostic des FOL et dans l'évaluation de la réussite des tentatives de réduction. Aussi les auteurs ont-ils procédé à un examen exhaustif de la documentation médicale sur l'utilisation de l'EPS dans le diagnostic et la réduction des FOL, et ils font état des résultats dans le présent article. Source de données: Des recherches ont été effectuées dans les bases de données MEDLINE et EMBASE jusqu'au 19 juillet 2015 inclusivement. Sélection des etudes: Ont été retenues des études prospectives visant à évaluer les caractéristiques de fonctionnement de l'EPS au regard 1) du diagnostic ou 2) de la réduction des FOL. La qualité méthodologique des études sélectionnées a été évaluée l'aide de l'outil Quality Assessment of Diagnostic Accuracy Studies (QUADAS-2). Extraction des données: Trente études respectaient les critères de sélection (n = 3506; taux général de fracture : 48,0 %). Les caractéristiques de fo...

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Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Meta-analysis Of Selected Studiesmentioning

confidence: 99%

Section: Risk Of Biasmentioning

confidence: 99%

See 2 more Smart Citations

Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis

Chartier

Bosco

Lapointe‐Shaw

et al. 2016

CJEM

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“…After these exclusions, seven studies were identified by EMBASE, and seven studies by PUBMED. Of these, six were common to both searches (Chen et al, 34 Chaar-Alvarez et al, 35 Cross et al, 36 Chien et al, 37 Marshburn et al, 38 and Tayal et al 39 ), one additional reference was identified by EMBASE and not by PUBMED search (Sinha et al 40 ), and one study was identified by PUBMED and not by EMBASE search (Patel et al 41 ), for a total of eight studies included in our review.…”

Section: Description Of Included Studies: Bedside Ultrasoundmentioning

confidence: 99%

Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review

Joshi

Lira

Mehta

et al. 2013

Academic Emergency Medicine

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Objectives: Understanding history, physical examination, and ultrasonography (US) to diagnose extremity fractures compared with radiography has potential benefits of decreasing radiation exposure, costs, and pain and improving emergency department (ED) resource management and triage time. Methods:The authors performed two electronic searches using PubMed and EMBASE databases for studies published between 1965 to 2012 using a strategy based on the inclusion of any patient presenting with extremity injuries suspicious for fracture who had history and physical examination and a separate search for US performed by an emergency physician (EP) with subsequent radiography. The primary outcome was operating characteristics of ED history, physical examination, and US in diagnosing radiologically proven extremity fractures. The methodologic quality of the studies was assessed using the quality assessment of studies of diagnostic accuracy tool (QUADAS-2).Results: Nine studies met the inclusion criteria for history and physical examination, while eight studies met the inclusion criteria for US. There was significant heterogeneity in the studies that prevented data pooling. Data were organized into subgroups based on anatomic fracture locations, but heterogeneity within the subgroups also prevented data pooling. The prevalence of fracture varied among the studies from 22% to 70%. Upper extremity physical examination tests have positive likelihood ratios (LRs) ranging from 1.2 to infinity and negative LRs ranging from 0 to 0.8. US sensitivities varied between 85% and 100%, specificities varied between 73% and 100%, positive LRs varied between 3.2 and 56.1, and negative LRs varied between 0 and 0.2. Conclusions:Compared with radiography, EP US is an accurate diagnostic test to rule in or rule out extremity fractures. The diagnostic accuracy for history and physical examination are inconclusive. Future research is needed to understand the accuracy of ED US when combined with history and physical examination for upper and lower extremity fractures.ACADEMIC EMERGENCY MEDICINE 2013; 20:1-15 © 2013 by the Society for Academic Emergency Medicine E xtremity injuries are among the most frequent reasons for visiting the emergency department (ED). These injuries are significant, comprising over 42.4 million injury-related visits to the ED in 2006. 1The typical work-up of the injured patient generally involves a medical provider obtaining a history and physical examination, often followed by radiologic imaging. However, many times the radiologic imaging may be negative or inconclusive, which calls to question whether the imaging contributed to the management or outcome of the patient. Studies have shown that often the imaging obtained is unnecessary and results in radiation exposure to patients and increased ED wait times. 2There is a low rate of positive radiography when assessing for fractures as evidenced by a retrospective review by Bentohami et al.,3 in which only 50% of upper extremity x-rays showed fractures, and another ...

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Point-of-Care Ultrasound in Pediatric Clinical Care

McLario

Sivitz

2015

JAMA Pediatr

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Lower respiratory tract infections (LRTIs) are the leading cause of deaths in children < 5 years old worldwide, particularly affecting low-resource settings such as Aweil, South Sudan. In these settings, diagnosis can be difficult because of either lack of access to radiography or clinical algorithms that overtreat children with antibiotics who only have viral LRTIs. Point-of-care ultrasound (POCUS) has been applied to LRTIs, but not by nonphysician clinicians, and with limited data from low-resource settings. Our goal was to examine the feasibility of training the mid-level provider cadre clinical officers (COs) in a Médecins Sans Frontières project in South Sudan to perform a POCUS algorithm to differentiate among causes of LRTI. Six COs underwent POCUS training, and each subsequently performed 60 lung POCUS studies on hospitalized pediatric patients < 5 years old with criteria for pneumonia. Two blinded experts, with a tiebreaker expert adjudicating discordant results, served as a reference standard to calculate test performance characteristics, assessed image quality and CO interpretation. The COs performed 360 studies. Reviewers rated 99.1% of the images acceptable and 86.0% CO interpretations appropriate. The inter-rater agreement (κ) between COs and experts for lung consolidation with air bronchograms was 0.73 (0.63-0.82) and for viral LRTI/bronchiolitis was 0.81 (0.74-0.87). It is feasible to train COs in South Sudan to use a POCUS algorithm to diagnose pneumonia and other pulmonary diseases in children < 5 years old.

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Bedside Ultrasound Diagnosis of Nonangulated Distal Forearm Fractures in the Pediatric Emergency Department

Cited by 77 publications

References 26 publications

Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis

Use of point-of-care ultrasound in long bone fractures: a systematic review and meta-analysis

Diagnostic Accuracy of History, Physical Examination, and Bedside Ultrasound for Diagnosis of Extremity Fractures in the Emergency Department: A Systematic Review

Point-of-Care Ultrasound in Pediatric Clinical Care

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