Point‐of‐Care Ultrasound Pronator Quadratus Hematoma Sign for Detection of Clinically Non‐Angulated Pediatric Distal Forearm Fractures: A Prospective Cohort Study

2021 ◽  
Author(s):  
Peter J. Snelling ◽  
Gerben Keijzers ◽  
Robert S. Ware
Keyword(s):  
Cohort Study ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Pronator Quadratus ◽  
Distal Forearm Fractures

scholarly journals 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

2020 ◽  
pp. emermed-2020-209689
Author(s):  
Peter J Snelling ◽  
Philip Jones ◽  
Gerben Keijzers ◽  
David Bade ◽  
David W Herd ◽  
...  
Keyword(s):  
Diagnostic Accuracy ◽  
Nurse Practitioners ◽  
Point Of Care ◽  
Point Of Care Ultrasound ◽  
Diagnostic Study ◽  
X Rays ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
X Ray ◽  
Distal Forearm Fractures

BackgroundPaediatric distal forearm fractures are a common ED presentation. They can be diagnosed with point-of-care ultrasound (POCUS) as an alternative to X-rays. Given that ED nurse practitioners (NPs) are relied on for the diagnosis of paediatric fractures, it is important to describe the diagnostic accuracy of NP-conducted POCUS versus X-ray.MethodsThis prospective diagnostic study was conducted in a tertiary paediatric hospital in Queensland, Australia, between February 2018 and April 2019. Participants were children aged 4–16 years with a clinically non-angulated, suspected distal forearm fracture. Diagnosis from 6-view NP-administered POCUS of the distal radius and ulna was compared against the reference standard of 2-view X-ray. Each patient received both imaging modalities. Overall forearm diagnosis was classified as ‘no’, ‘buckle’ or ‘other’ fracture for both modalities. The primary outcome was diagnostic accuracy for ‘any’ fracture (‘buckle’ and ‘other’ fractures combined). Secondary outcomes included diagnostic accuracy for ‘other’ fractures versus ‘buckle’ and ‘no’ fractures combined, and pain, imaging duration and preference for modality.ResultsOf 204 recruited patients, 129 had X-ray-diagnosed forearm fractures. The sensitivity and specificity for NP-administered POCUS were 94.6% (95% CI 89.2% to 97.3%) and 85.3% (95% CI 75.6% to 91.6%), respectively. ‘Other’ fractures (mostly cortical breach fractures), when compared with ‘buckle’/ ‘no’ fractures, had sensitivity 81.0% (95% CI 69.1% to 89.1%) and specificity 95.9% (95% CI 91.3% to 98.1%). Pain and imaging duration were clinically similar between modalities. There was a preference for POCUS by patients, parents and NPs.ConclusionsNP-administered POCUS had clinically acceptable diagnostic accuracy for paediatric patients presenting with non-angulated distal forearm injuries. This included good sensitivity for diagnosis of ‘any’ fracture and good specificity for diagnosis of cortical breach fractures alone. Given the preference for POCUS, and the lack of difference in pain and duration between modalities, future research should consider functional outcomes comparing POCUS with X-ray in this population in a randomised controlled trial.

Point-of-care ultrasound compared with conventional radiographic evaluation in children with suspected distal forearm fractures in the Netherlands: a diagnostic accuracy study

2019 ◽  
Vol 36 (10) ◽  
pp. 613-616 ◽  
Author(s):  
Anniek C Epema ◽  
Mariëlle J B Spanjer ◽  
Lieselotte Ras ◽  
Johannes C Kelder ◽  
Marieke Sanders
Keyword(s):  
The Netherlands ◽  
Diagnostic Accuracy ◽  
Conventional Radiography ◽  
Point Of Care Ultrasound ◽  
Distal Forearm ◽  
Forearm Fractures ◽  
Predictive Values ◽  
Pain Scores ◽  
Fractures In Children ◽  
Distal Forearm Fractures

BackgroundDistal 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.ObjectiveThe 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.MethodsChildren, 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.Results100 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).ConclusionsIn 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.

scholarly journals Point-of-care lung ultrasound predicts severe disease and death due to COVID-19: a prospective cohort study.

2022 ◽  
Author(s):  
Paul W Blair ◽  
Trishul Siddharthan ◽  
Gigi Liu ◽  
Jiawei Bai ◽  
Joshua East ◽  
...  
Keyword(s):  
Cohort Study ◽  
Disease Progression ◽  
Prospective Cohort Study ◽  
Prospective Cohort ◽  
Lung Ultrasound ◽  
Point Of Care ◽  
Tertiary Care ◽  
High Flow ◽  
Pleural Line ◽  
High Flow Oxygen

Objective: The clinical utility of point-of-care lung ultrasound (LUS) for disease severity triage of hospitalized patients with COVID-19 is unclear. Design: Prospective cohort study Setting: A large tertiary care center in Maryland, USA between April 2020 to September 2021. Patients: Hospitalized adults (18 years of age or greater) with positive SARS-CoV-2 RT-PCR results. Interventions: None. Measurements and Main Results: All patients were scanned using a standardized protocol including 12 lung zones and followed to determine clinical outcomes until hospital discharge and vital status at 28-days. Ultrasounds were independently reviewed for lung and pleural line artifacts and abnormalities, and the mean Lung Ultrasound Score (ranging from 0 to 3) across lung zones (mLUSS) was determined. The primary outcome was time to ICU-level care, defined as high flow oxygen, noninvasive, or mechanical ventilation, within 28-days of the initial ultrasound. Cox proportional hazards regression models adjusted for age and sex were fit for mLUSS and each ultrasound covariate. A total of 264 participants were enrolled in the study; the median age was 59 years and 114 (43.2) % of participants were female. The median mLUSS was 1 (interquartile range: 0.5 to 1.3). Following enrollment, 29 (11.0%) participants went on to require ICU-level care and 14 (5.3%) subsequently died by 28 days. Each increase in mLUSS at enrollment was associated with disease progression to ICU-level care (aHR = 3.63; 95% CI: 1.23 to 10.65) and 28-day mortality (aHR = 4.50; 95% CI: 1.52 to 13.31). Pleural line abnormalities were independently associated with disease progression to ICU-level care (aHR = 18.86; CI: 1.57 to 226.09). Conclusions: Participants with a mLUSS of 1 or more or pleural line changes on LUS had an increased likelihood of subsequent requirement of high flow oxygen or greater. LUS is a promising tool for assessing risk of COVID-19 progression at the bedside.

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