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.
Key Words
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Article info
Publication history
Published online: October 20, 2020
Accepted:
September 8,
2020
Received:
August 11,
2020
Identification
Copyright
© 2020 World Federation for Ultrasound in Medicine & Biology. All rights reserved.
