Ultrasound imaging of forearm fractures in children: a viable alternative?

Williamson, Dominic; Watura, Roland; Cobby, Mark

doi:10.1136/emj.17.1.22

Cited by 85 publications

(67 citation statements)

References 10 publications

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“…48 In addition to eight articles that had not been published at that time, 20,[26][27][28]32,33,41,46 our study includes thirteen other articles not included in that review. 21,22,24,25,29,30,[34][35][36]38,41,43,44 Additional studies were possibly found as a result of a more comprehensive search strategy. Our review reaches similar conclusions, that PoCUS is a useful tool to supplement radiographs for the detection of fractures.…”

Section: Discussionmentioning

confidence: 99%

“…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%

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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: Discussionmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Study Characteristicsmentioning

confidence: 99%

Section: Meta-analysis Of Selected Studiesmentioning

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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“…11 Multiple studies show that ultrasound for fracture diagnosis has good accuracy when used by clinicians [12][13][14][15] as well as when used by radiologists. 16,17 In addition, ultrasound is well tolerated by children, even in areas of injury. 12,15 Emerging data suggest that ultrasound diagnosis of skull fractures in children is promising, 13,15,[17][18][19][20] and additional investigation of its utility is warranted.…”

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confidence: 99%

Accuracy of Point-of-Care Ultrasound for Diagnosis of Skull Fractures in Children

et al. 2013

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WHAT'S KNOWN ON THIS SUBJECT: Head injuries and concern for skull fracture are common in pediatrics. Point-of-care ultrasound is an imaging tool that can be used to diagnose fractures. However, there are scant data regarding the accuracy of point-ofcare ultrasound in skull fracture diagnosis. WHAT THIS STUDY ADDS:Clinicians with focused point-of-care ultrasound training are able to diagnose skull fractures in children with high specificity. Ultrasound may be valuable to diagnose skull fractures in children at the point of care. abstract OBJECTIVE: To determine the test performance characteristics for point-of-care ultrasound performed by clinicians compared with computed tomography (CT) diagnosis of skull fractures. METHODS:We conducted a prospective study in a convenience sample of patients #21 years of age who presented to the emergency department with head injuries or suspected skull fractures that required CT scan evaluation. After a 1-hour, focused ultrasound training session, clinicians performed ultrasound examinations to evaluate patients for skull fractures. CT scan interpretations by attending radiologists were the reference standard for this study. Pointof-care ultrasound scans were reviewed by an experienced sonologist to evaluate interobserver agreement.RESULTS: Point-of-care ultrasound was performed by 17 clinicians in 69 subjects with suspected skull fractures. The patients' mean age was 6.4 years (SD: 6.2 years), and 65% of patients were male. The prevalence of fracture was 12% (n = 8). Point-of-care ultrasound for skull fracture had a sensitivity of 88% (95% confidence interval [CI]: 53%-98%), a specificity of 97% (95% CI: 89%-99%), a positive likelihood ratio of 27 (95% CI: 7-107), and a negative likelihood ratio of 0.13 (95% CI: 0.02-0.81). The only false-negative ultrasound scan was due to a skull fracture not directly under a scalp hematoma, but rather adjacent to it. The k for interobserver agreement was 0.86 (95% CI: 0.67-1.0). CONCLUSIONS:Clinicians with focused ultrasound training were able to diagnose skull fractures in children with high specificity. Pediatrics

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Ultrasound for Bony Trauma

Brooks¹,

Williams²

2004

Ultrasound in Emergency Care

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Ultrasound imaging of forearm fractures in children: a viable alternative?

Cited by 85 publications

References 10 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

Accuracy of Point-of-Care Ultrasound for Diagnosis of Skull Fractures in Children

Ultrasound for Bony Trauma

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