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Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study
  1. Anniek C Epema1,
  2. Mariëlle J B Spanjer2,
  3. Lieselotte Ras2,
  4. Johannes C Kelder3,
  5. Marieke Sanders2
  1. 1 Department of Emergency Medicine, Diakonessenhuis Utrecht Zeist Doorn Locatie Utrecht, Utrecht, The Netherlands
  2. 2 Department of Emergency Medicine, St Antonius Hospital, Nieuwegein, the Netherlands
  3. 3 Department of Clinical Epidemiology, St Antonius Hospital, Nieuwegein, the Netherlands
  1. Correspondence to Anniek C Epema, Emergency Department, Diakonessenhuis, Utrecht 3508, The Netherlands; aepema{at}diakhuis.nl

Abstract

Background Distal 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.

Objective The 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.

Methods Children, 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.

Results 100 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).

Conclusions In 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.

  • emergency department
  • imaging, ultrasound
  • imaging, X-ray
  • musculo-skeletal, fractures and dislocations
  • paediatrics
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Footnotes

  • ACE and MJBS contributed equally.

  • Contributors ACE and MJBS: contributed equally to this paper. ACE: principal investigator, contributed to the conception and design of the work; took part in acquisition of data and database management; took part in revising the work; given final approval; agreed to be accountable for all aspects of the work. MJBS: had the lead in acquisition of data and database management; took part in interpretation of data; had the co-lead in drafting and revising the work; given final approval; agreed to be accountable for all aspects of the work. LR: contributed to the design of the work and the interpretation of data; had the co-lead in drafting and revising the work; given final approval; agreed to be accountable for all aspects of the work. JCK: contributed to the design of the work and analysis of the data; took part in revising the work; given final approval; agreed to be accountable for all aspects of the work. MS: contributed to the design of the work and the acquisition and interpretation of data; took part in revising the work; given final approval; agreed to be accountable for all aspects of the work.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Patient consent for publication Not required.

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