Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study

Abstract

BackgroundDistal forearm fractures are common in children. The reference standard to diagnose these fractures is by conventional radiography, which exposes these patients to harmful radiation. Ultrasound (US) seems to be a good alternative. However, emergency physicians (EPs) in the Netherlands have limited experience in using US for diagnosing fractures in children.ObjectiveThe primary objective was to determine the accuracy of US, performed by a Dutch EP, compared with conventional radiography, in diagnosing distal forearm fractures in children. As a secondary objective, differences in pain scores during the performance of both US and plain radiography were determined.MethodsChildren, aged between 0 and 14 years old, suspected of having a distal forearm fracture were enrolled at the Emergency Department. US and radiographic findings were compared. Statistics for accuracy were calculated. Pain scores were recorded during US and radiography and compared as well. All participating operators received an hour-long pretrial training.Results100 patients were enrolled. The mean age was 9.5 years (SD, 3.6), and 50% were women. Overall diagnostic accuracy was 92% (95% CI 85%-96%). The sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios for US were 95% (95% CI 87% to 99%), 86% (95% CI 71% to 95%), 92% (95% CI 83% to 97%), 91% (95% CI 76% to 98%), 6.86 (95% CI 3.04 to 15.51) and 0.05 (95% CI 0.02 to 0.17), respectively. The pain scores during US and radiographic imaging were 3.3 and 4.6, respectively (p<0.01).ConclusionsIn this study, we showed that US is an accurate method for diagnosing distal forearm fractures in children. The main advantages are that it is radiation-free and rapidly practicable, and that patients experience it as less painful than radiography. Moreover, this study has proven that with minimal experience in US, good diagnostic accuracy can be achieved after brief training.

Nurse practitioner administered point-of-care ultrasound compared with X-ray for children with clinically non-angulated distal forearm fractures in the ED: a diagnostic study

“…The diagnostic characteristics of NP-administered POCUS for paediatric distal forearm fractures were comparable to previous studies of POCUS performed by other clinicians within the ED. [10][11][12] In contrast to other studies, our study focused on NPs who were true novices to POCUS, with no prior POCUS experience. The benefit of training NPs is their ubiquity as costeffective primary care providers in both urban and rural settings.…”

“…Patients reported similar pain scores and parents reported lower pain scores for POCUS versus x-ray, in keeping with other literature. [10][11][12] However, more patients (5.9%) than parents (1.5%) reported pain scores ≥6 for POCUS, which may have been due to the anxiety generated by the contact of the probe directly over the fracture site rather than physical pain. Administration of analgesia was similar between groups, apart from opioid analgesia, which was almost exclusively provided for patients with a cortical breach fracture.…”

“…7 Point-of-care ultrasound (POCUS), a portable form of non-ionising imaging conducted at the patient bedside, has been proposed as a potential alternative. [8][9][10][11][12][13][14] Buckle fractures can be conservatively managed akin to soft tissue injuries. 5 If they can be reliably distinguished from other fractures using POCUS, x-rays can potentially be avoided, 15 which supports the 'as low as reasonably achievable' principle.…”

Diagnostic Accuracy of 3D Ultrasound and Artificial Intelligence for Detection of Pediatric Wrist Injuries

“…It has the advantages of being inexpensive and portable while being able to reveal cortical disruption, periosteal fluid, and joint effusion to aid in detecting fractures. The use of US in pediatric distal radius fractures has been validated to have similar accuracy compared to radiography [ 6 , 7 , 8 , 9 , 10 , 11 ]. A recent meta-analysis identified 16 studies with 1204 patients, resulting in 97% sensitivity and 95% specificity [ 12 ].…”

Demonstration of a Longitudinal Action Medical Mission (LAMM) Model to Teach Point-of-Care Ultrasound in Resource-Limited Settings

“…Namely, point-of-care ultrasound (POCUS) is a reliable diagnostic tool that affords clinicians the ability to examine patients in real time and make clinical assessments without the expense, delay, or radiation associated with other imaging modalities [2]. Given its profound versatility, usability, and low training requirements, POCUS is emerging as an increasingly important tool for bedside diagnosis [3][4][5][6][7][8][9].…”