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Accuracy of Point-of-Care Ultrasound in Detecting Fractures in Children: A Validation Study

      Abstract

      This study sought to compare point-of-care ultrasound (POCUS) and conventional X-rays for detecting fractures in children. This was a prospective, non-randomized, convenience-sample study conducted in five medical centers. It evaluated pediatric patients with trauma. POCUS and X-ray examination results were treated as dichotomous variables with fracture either present or absent. Descriptive statistics were calculated in addition to prevalence, sensitivity, specificity, positive predictive value and negative predictive value, including 95% confidence intervals (CIs). The Cohen κ coefficient was determined as a measurement of the level of agreement. A total of 554 examinations were performed with POCUS and X-ray. On physical examination, swelling, localized hematoma and functional limitation were found in 66.73%, 33.78% and 53.74% of participants, respectively. The most-studied areas were limbs and hands/feet (58.19% and 38.27%), whereas the thorax was less represented (3.54%). Sensitivity of POCUS was 91.67% (95% CI, 76.41–97.82%) for high-skill providers and 71.50 % (95% CI, 64.75–77.43%) for standard-skill providers. Specificity was 88.89% (95% CI, 73.00–96.34%) and 82.91% (95% CI, 77.82–87.06%) for high- and standard-skill providers, respectively. Positive predictive value was 89.19% (95% CI, 73.64–96.48%) and 75.90% (95% CI, 69.16–81.59%) for high- and standard-skill providers, respectively. Negative predictive value was 91.43% (95% CI, 75.81–97.76%) and 79.44% (95% CI, 74.21–83.87%) for high- and standard-skill providers, respectively. The Cohen κ coefficient showed very good agreement (0.81) for high-skill providers, but moderate agreement (0.54) for standard-skill providers. We noted good diagnostic accuracy of POCUS in evaluating fracture, with excellent sensitivity, specificity, and positive and negative predictive value for high-skill providers.

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      References

        • Alpern ER
        • Stanley RM
        • Gorelick MH
        • Donaldson A
        • Knight S
        • Teach SJ
        • et al.
        Pediatric Emergency Care Applied Research Network. Epidemiology of a paediatric emergency medicine research network: The PECARN Core Data Project.
        Pediatr Emerg Care. 2006; 22: 689-699
        • Caroselli C
        • Zaccaria E
        • Blaivas M
        • Dib G
        • Fiorentino R
        • Longo D
        A pilot prospective study to validate point-of-care ultrasound in comparison to X-ray examination in detecting fractures.
        Ultrasound Med Biol. 2020; 46: 11-19
        • Chaar-Alvarez FM
        • Warkentine F
        • Cross K
        • Herr S
        • Ri P
        Bedside ultrasound diagnosis of nonangulated distal forearm fractures in the pediatric emergency department.
        Pediatr Emerg Care. 2011; 27: 1027-1032
        • Chen L
        • Kim Y
        • Moore CL
        Diagnosis and guided reduction of forearm fractures in children using bedside ultrasound.
        Pediatr Emerg Care. 2007; 23: 528-531
        • Chien M
        • Bulloch B
        • Garcia-Filion P
        • Youssfi M
        • Shrader MW
        • Segal LS
        Bedside ultrasound in the diagnosis of pediatric clavicle fractures.
        Pediatr Emerg Care. 2011; 27: 1038-1041
        • Cross KP
        • Warkentine FH
        • Kim IK
        • Gracely E
        • Paul RI
        Bedside ultrasound diagnosis of clavicle fractures in the pediatric emergency department.
        Acad Emerg Med. 2010; 17: 687-693
        • Douma-den Hamer D
        • Blanker MH
        • Edens MA
        • N Buijteweg L
        • Boomsma M
        • van Helden SH
        • Mauritz G-J
        Ultrasound for distal forearm fracture: A systematic review and diagnostic meta-analysis.
        PLoS One. 2016; 11e0155659
        • Epema AC
        • Spanjer MJB
        • Ras L
        • Kelder JC
        • Sanders M
        Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: A diagnostic accuracy study.
        Emerg Med J. 2019; 36: 613-616
        • Galletebeitia Laka I
        • Samson F
        • Gorostiza I
        • Gonzalez A
        • Gonzalez C
        The utility of clinical ultrasonography in identifying distal forearm fractures in the pediatric emergency department.
        Eur J Emerg Med. 2019; 26: 118-122
        • Gordon I
        • Sinert R
        • Chao J
        The utility of ultrasound in detecting skull fractures after pediatric blunt head trauma: Systematic review and meta-analysis.
        Pediatr Emerg Care. 2020; ([E-pub ahead of print])https://doi.org/10.1097/pec.0000000000001958
        • Hedelin H
        • Goksor LA
        • Karlsson J
        • Stjernstrom
        Ultrasound-assisted triage of ankle trauma can decrease the need for radiographic imaging.
        Am J Emerg Med. 2013; 31: 1686-1689
        • Kozaci N
        • Ay MO
        • Akcimen M
        • Turhan G
        • Sasmaz I
        • Turhan S
        • Celik A
        Evaluation of the effectiveness of bedside point-of-care ultrasound in the diagnosis and management of distal radius fractures.
        Am J Emerg Med. 2015; 33: 67-71
        • Kozaci N
        • Ay MO
        • Avci M
        • Turhan S
        • Donertas E
        • Celik A
        • Ararat E
        • Akgun E
        The comparison of point-of-care ultrasonography and radiography in the diagnosis of tibia and fibula fractures.
        Injury. 2017; 48: 1628-1635
        • Landis JR
        • Koch GG
        The Measurement of Observer Agreement for Categorical Data.
        Biometrics. 1977; 33: 159-174
        • Marin J
        • Abo AM
        • Arroyo AC
        • Doniger SJ
        • Fischer JW
        • Rempell R
        • Gary B
        • Holmes JF
        • Kessler DO
        • Lam SHF
        • Levine MC
        • Levy JA
        • Murray A
        • Ng L
        • Noble VE
        • Ramirez-Schrempp D
        • Riley DC
        • Saul T
        • Shah V
        • Sivitz AB
        • Tay ET
        • Teng D
        • Chaudoin L
        • Tsung JW
        • Vieira RL
        • Vitberg YM
        • Lewiss RE
        Pediatric emergency medicine point-of-care ultrasound: Summary of the evidence.
        Crit Ultrasound J. 2016; 8: 16
        • Metz VM
        • Gilula LA.
        Imaging techniques for distal radius fractures and related injuries.
        Orthop Clin North Am. 1993; 24: 217-228
        • Neri E
        • Barbi E
        • Rabach I
        • Zanchi C
        • Norbedo S
        • Ronfani L
        • Guastalla V
        • Ventura A
        • Guastalla P
        Diagnostic accuracy of ultrasonography for hand bony fractures in paediatric patients.
        Arch Dis Child. 2014; 99: 1087-1090
        • Patel DD
        • Blumberg SM
        • Crain EF
        The utility of bedside ultrasonography in identifying fractures and guiding fracture reduction in children.
        Pediatr Emerg Care. 2009; 25: 221-225
        • Poonai N
        • Myslik F
        • Joubert G
        • Fan J
        • Misir A
        • Istasy V
        Point-of-care ultrasound for nonangulated distal forearm fractures in children: Test performance characteristics and patient-centered outcomes.
        Acad Emerg Med. 2017; 24: 607-616
        • Rabiner JE
        • Friedman LM
        • Khine H
        • Avner JR
        • Tsung JW
        Accuracy of point-of-care ultrasound for diagnosis of skull fractures in children.
        Pediatrics. 2013; 131: e1757-e1764
        • Rowlands R
        • Rippey J
        • Tie S
        • Flynn J
        Bedside ultrasound vs X-ray for the diagnosis of forearm fractures in children.
        J Emerg Med. 2017; 52: 208-215
        • Tessaro MO
        • McGovern TR
        • Dickman E
        • Haines LE
        Point-of-care ultrasound detection of acute scaphoid fracture.
        Pediatr Emerg Care. 2015; 31: 222-224
        • Weinberg ER
        • Tunik MG
        • Tsung JW
        Accuracy of clinician performed point-of-care ultrasound for the diagnosis of fractures in children and young adults.
        Injury. 2010; 41: 862-868
        • World Health Organization
        World report on child injury prevention.
        World Health Organization, Geneva, Switzerland2008