Diagnosis of suspected pediatric distal forearm fractures with point-of-care-ultrasound (POCUS) by pediatric orthopedic surgeons after minimal training.
Humans
Child
Ultrasonography
/ methods
Female
Male
Adolescent
Point-of-Care Systems
Radius Fractures
/ diagnostic imaging
Retrospective Studies
Ulna Fractures
/ diagnostic imaging
Orthopedic Surgeons
/ education
Child, Preschool
Sensitivity and Specificity
Emergency Service, Hospital
Forearm Injuries
/ diagnostic imaging
Germany
Infant
Radiography
/ methods
Wrist Fractures
Child
Distal Forearm Fractures
Fracture Ultrasound
Human distal forearm fractures
Retrospective study
Ultrasonography
Ultrasound
Wrist-POCUS
X-rays
Journal
BMC medical imaging
ISSN: 1471-2342
Titre abrégé: BMC Med Imaging
Pays: England
ID NLM: 100968553
Informations de publication
Date de publication:
27 Sep 2024
27 Sep 2024
Historique:
received:
21
07
2023
accepted:
18
09
2024
medline:
28
9
2024
pubmed:
28
9
2024
entrez:
28
9
2024
Statut:
epublish
Résumé
Several studies have advocated the use of ultrasound to diagnose distal forearm fractures in children. However, there is limited data on the diagnostic accuracy of ultrasound for distal forearm fractures when conducted by pediatric surgeons or trainees who manage orthopedic injuries in children. The objective of this study was to determine the diagnostic accuracy of point-of-care ultrasound (POCUS) for pediatric distal forearm fractures when conducted by pediatric surgeons and trainees after minimal training. This diagnostic study was conducted in a tertiary hospital emergency department in Germany. Participants were children and adolescents under 15 years of age who presented to the emergency department with an acute, suspected, isolated distal forearm fracture requiring imaging. Pediatric surgeons and trainees, after minimal training for sonographic fracture diagnosis, performed 6-view distal forearm POCUS on each participant prior to X-ray imaging. All data was retrospectively collected from the hospital's routine digital patient files. The primary outcome was the diagnostic accuracy of POCUS compared to X-ray as the reference standard. From February to June 2021, 146 children under 15 met all inclusion and exclusion criteria, and 106 data sets were available for analysis. Regarding the presence of a fracture, X-ray and Wrist-POCUS showed the same result in 99.1%, with 83/106 (78.3%) fractures detected in both modalities and one suspected buckle fracture on POCUS not confirmed in the radiographs. Wrist-POCUS had a sensitivity of 100% (95% CI [0.956, 1]) and a specificity of 95.8% (95% CI [0.789, 0.999]) compared to radiographs. In 6 cases, there were minor differences regarding a concomitant ulnar buckle. The amount of prior ultrasound training had no influence on the accuracy of Wrist-POCUS for diagnosing distal forearm fractures. All fractures were reliably diagnosed even when captured POCUS images did not meet all quality criteria. Pediatric surgeons and trainees, after minimal training in POCUS, had excellent diagnostic accuracy for distal forearm fractures in children and adolescents using POCUS compared to X-ray.
Sections du résumé
BACKGROUND
BACKGROUND
Several studies have advocated the use of ultrasound to diagnose distal forearm fractures in children. However, there is limited data on the diagnostic accuracy of ultrasound for distal forearm fractures when conducted by pediatric surgeons or trainees who manage orthopedic injuries in children. The objective of this study was to determine the diagnostic accuracy of point-of-care ultrasound (POCUS) for pediatric distal forearm fractures when conducted by pediatric surgeons and trainees after minimal training.
METHODS
METHODS
This diagnostic study was conducted in a tertiary hospital emergency department in Germany. Participants were children and adolescents under 15 years of age who presented to the emergency department with an acute, suspected, isolated distal forearm fracture requiring imaging. Pediatric surgeons and trainees, after minimal training for sonographic fracture diagnosis, performed 6-view distal forearm POCUS on each participant prior to X-ray imaging. All data was retrospectively collected from the hospital's routine digital patient files. The primary outcome was the diagnostic accuracy of POCUS compared to X-ray as the reference standard.
RESULTS
RESULTS
From February to June 2021, 146 children under 15 met all inclusion and exclusion criteria, and 106 data sets were available for analysis. Regarding the presence of a fracture, X-ray and Wrist-POCUS showed the same result in 99.1%, with 83/106 (78.3%) fractures detected in both modalities and one suspected buckle fracture on POCUS not confirmed in the radiographs. Wrist-POCUS had a sensitivity of 100% (95% CI [0.956, 1]) and a specificity of 95.8% (95% CI [0.789, 0.999]) compared to radiographs. In 6 cases, there were minor differences regarding a concomitant ulnar buckle. The amount of prior ultrasound training had no influence on the accuracy of Wrist-POCUS for diagnosing distal forearm fractures. All fractures were reliably diagnosed even when captured POCUS images did not meet all quality criteria.
CONCLUSION
CONCLUSIONS
Pediatric surgeons and trainees, after minimal training in POCUS, had excellent diagnostic accuracy for distal forearm fractures in children and adolescents using POCUS compared to X-ray.
Identifiants
pubmed: 39334059
doi: 10.1186/s12880-024-01433-y
pii: 10.1186/s12880-024-01433-y
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
255Informations de copyright
© 2024. The Author(s).
Références
Larsen AV, Mundbjerg E, Lauritsen JM, Faergemann C. Development of the annual incidence rate of fracture in children 1980–2018: a population-based study of 32,375 fractures. Acta Orthop. 2020;91(5):593–7.
doi: 10.1080/17453674.2020.1772555
pubmed: 32500789
pmcid: 8023904
Cintean R, Eickhoff A, Zieger J, Gebhard F, Schütze K. Epidemiology, patterns, and mechanisms of pediatric trauma: a review of 12,508 patients. Eur J Trauma Emerg Surg Off Publ Eur Trauma Soc. 2023;49(1):451–9.
doi: 10.1007/s00068-022-02088-6
Shah AS, Guzek RH, Miller ML, Willey MC, Mahan ST, Bae DS, et al. Descriptive epidemiology of isolated distal radius fractures in children: results from a prospective multicenter registry. J Pediatr Orthop. 2023;43(1):e1-8.
doi: 10.1097/BPO.0000000000002288
pubmed: 36299238
Williamson D, Watura R, Cobby M. Ultrasound imaging of forearm fractures in children: a viable alternative? J Accid Emerg Med. 2000;17(1):22–4.
doi: 10.1136/emj.17.1.22
pubmed: 10658986
pmcid: 1756269
Ackermann O, Liedgens P, Eckert K, Chelangattucherry E, Ruelander C, Emmanouilidis I, et al. Ultrasound diagnosis of juvenile forearm fractures. J Med Ultrason. 2010;37(3):123–7.
doi: 10.1007/s10396-010-0263-x
Herren C, Sobottke R, Ringe MJ, Visel D, Graf M, Müller D, et al. Ultrasound-guided diagnosis of fractures of the distal forearm in children. Orthop Traumatol Surg Res. 2015;101(4):501–5.
doi: 10.1016/j.otsr.2015.02.010
pubmed: 25910703
Douma-Den Hamer D, Blanker MH, Edens MA, Buijteweg LN, Boomsma MF, Van Helden SH, et al. Ultrasound for distal forearm fracture: a systematic review and diagnostic meta-analysis. PLoS One. 2016;11(5):e0155659.
Katzer C, Wasem J, Eckert K, Ackermann O, Buchberger B. Ultrasound in the diagnostics of metaphyseal forearm fractures in children: a systematic review and cost calculation. Pediatr Emerg Care. 2016;32:401–7.
doi: 10.1097/PEC.0000000000000446
pubmed: 26087441
Poonai N, Myslik F, Joubert G, Fan J, Misir A, Istasy V, et al. Point-of-care ultrasound for nonangulated distal forearm fractures in children: test performance characteristics and patient-centered outcomes. Acad Emerg Med. 2017;24(5):607–16.
doi: 10.1111/acem.13146
pubmed: 27976448
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(10):613–6.
doi: 10.1136/emermed-2018-208380
pubmed: 31530583
Snelling PJ, Jones P, Keijzers G, Bade D, Herd DW, Ware RS. 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. Emerg Med J. 2021;38(2):139–45.
doi: 10.1136/emermed-2020-209689
pubmed: 32900856
Snelling PJ, Jones P, Bade D, Bindra R, Byrnes J, Davison M, et al. Ultrasonography or radiography for suspected pediatric distal forearm fractures. N Engl J Med. 2023;388(22):2049–57.
doi: 10.1056/NEJMoa2213883
pubmed: 37256975
Grechenig W, Clement HG, Schatz B, Grechenig M. Stellenwert der Sonographie am Stütz- und Bewegungs - apparat - unter besonderer Berücksichtigung von Strahlenbelastung und Kostenreduktion - the value of ultrasonography of the locomotory system with special consideration being given to radiation exposure and cost reduction. Biomedical Engineering/Biomedizinische Technik. 1997;42(5):132–7.
Ackermann O, Wojciechowski P, Dzierzega M, Grosser K, Schmitz-Franken A, Rudolf H, et al. Sokrat II - an international, prospective, multicenter, phase IV diagnostic trial to evaluate the efficacy of the wrist safe algorithm in fracture sonography of distal forearm fractures in children. Ultraschall Med Stuttg Ger 1980. 2019;40(3):349–58.
Ackermann O EK. Dokumentationsempfehlung wrist-safe. https://www.degum.de/fileadmin/dokumente/sektionen/chirurgie/Dokumentations-Empfehlungen/HandgelenkSAFE.pdf . downloaded December 6, 2021.
Mobasseri A, Noorifard P. Ultrasound in the diagnosis of pediatric distal radius fractures: does it really change the treatment policy? An orthopedic view. J Ultrason. 2022;22(90):e179–82.
Cohen JF, Korevaar DA, Altman DG, Bruns DE, Gatsonis CA, Hooft L, et al. STARD 2015 guidelines for reporting diagnostic accuracy studies: explanation and elaboration. BMJ Open. 2016;6(11):e012799.
doi: 10.1136/bmjopen-2016-012799
pubmed: 28137831
pmcid: 5128957
Alzen G, Benz-Bohm G. Radiation Protection in Pediatric Radiology. Dtsch Arztebl Int. 2011;108(24):407–14.
Wolf K, Bohndorf K, Vollert K, Kopp J. Diagnostic imaging and radiation protection in trauma surgery. 2. Unfallchirurg. 1996;99(12):975–85.
doi: 10.1007/s001130050083
pubmed: 9082568
Eckert K, Ackermann O, Schweiger B, Radeloff E, Liedgens P. Sonographic diagnosis of metaphyseal forearm fractures in children: a safe and applicable alternative to standard X-rays. Pediatr Emerg Care. 2012;28(9):851–4.
doi: 10.1097/PEC.0b013e318267a73d
pubmed: 22929137
Höfer J, Hoffmann F, Glaeske G, Sauer K. Distal forearm fractures in children and adolescents: frequency and health care provision in Germany. Gesundheitswesen Bundesverb Arzte Offentlichen Gesundheitsdienstes Ger. 2019;81(1):e1–9.
Perry DC, Achten J, Knight R, Appelbe D, Dutton SJ, Dritsaki M, et al. Immobilisation of torus fractures of the wrist in children (FORCE): a randomised controlled equivalence trial in the UK. Lancet Lond Engl. 2022;400(10345):39–47.
doi: 10.1016/S0140-6736(22)01015-7
Scheier E, Balla U. Ultrasound-guided distal forearm fracture reduction by pediatric emergency physicians: a single center retrospective study. Pediatr Emerg Care. 2022;38(2):e756–60.
doi: 10.1097/PEC.0000000000002464
pubmed: 34140450
Wawrzyk M, Sokal J, Andrzejewska E, Przewratil P. The role of ultrasound imaging of callus formation in the treatment of long bone fractures in children. Pol J Radiol. 2015;80:473–8.
doi: 10.12659/PJR.894548
pubmed: 26543512
pmcid: 4614376